Survival of Early Gastric Cancer in a Specialized European Center. Which Lymphadenectomy Is Necessary?

A clinicopathological study of early gastric cancer has been carried out in a single experienced surgical unit to identify prognostic indicators for survival and factors related to lymph nodes metastasis and document a survival benefit of D2 gastrectomy.

A retrospective review of our database from January 1990 to December 2004 revealed 189 patients with early gastric cancer undergoing surgical resection with either D1 or D2 lymph node dissection. Clinicopathological factors analyzed included Lauren’s histological type, histological differentiation, size, mucosal versus submucosal invasion, venous invasion, number of lymph node involved, and extent of nodal dissection performed. Factors related to increased risk of nodal metastases and predicting 5- and 10-year disease-specific survival were evaluated by univariate and multivariate analysis.

Median follow-up time was 77 months. Lymph node involvement was documented in 21.1% of patients. A D2 gastrectomy was performed in 56% of patients. The cumulative 10-year survival rate was 92.5%; it was strictly related to nodal metastases (p = .0014). Poor differentiation, size larger than 2 cm, and submucosal depth of invasion were related to increased risk of nodal metastases but not to decreased survival. Overall, 10-year survival after D2 gastrectomy was higher than after D1 gastrectomy (95 versus 87.5%), but this difference was not statistically significant (p = .80). No survival benefit was documented for D2 gastrectomy in subsets of patients with increased risk of nodal metastasis.

In this retrospective analysis a survival benefit of D2 gastrectomy was not documented either in the overall population or in subset analyses of patients with increased risk of nodal metastasis.