Published in:
01-06-2020 | Gastrectomy | Original Article
Gastrectomy with D2 Lymphadenectomy for Carcinoma of the Stomach in a Stand-alone Cancer Centre in Rural India
Published in: Indian Journal of Surgical Oncology | Issue 2/2020
Login to get accessAbstract
Context
The therapeutic role of D2 lymphadenectomy in the management of gastric cancer is an ongoing controversy.
Aims
To examine the morbidity and oncological outcomes of D2 lymph node dissection for gastric cancer patients treated in a stand-alone cancer center in rural India and to compare it with international data.
Settings and Design
Retrospective study on patients treated for gastric cancer from June 2009 to December 2014.
Methods and Material
All patients underwent subtotal or total gastrectomy with modified D2 lymph node dissection preserving spleen and pancreas. The Clavien-Dindo model was used to stratify the severity of morbidity.
Statistical analysis
Descriptive statistics was used for data exploration. Chi-square test was used to compare the association of various factors with survival. Kaplan-Meier method was used to calculate the survival rates (RFS and DFS). Log-rank test was used to compare the survival of different subgroups.
Results
Fifty-four patients (41 males and 13 females) were included in the study. Four (7.4%) patients had significant postoperative morbidity. The 5-year OS and DFS respectively were 34.9% and 37.6%. Female sex was associated with poorer survival. Lymph node ratio of more than 0.2 and advanced stage at presentation showed strong tendency towards lower OS and DFS.
Conclusions
An R0 resection with D2 lymphadenectomy for gastric cancer carries acceptable morbidity and mortality in Indian patients with survival rates comparable with the western studies. Lymph node ratio more than 0.2 and female gender and advanced stage were associated with poorer oncological outcomes.