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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2006

01-05-2006

Comparison of Surgical Results of D2 Versus D3 Gastrectomy (Para-Aortic Lymph Node Dissection) for Advanced Gastric Carcinoma: A Multi-Institutional Study

Authors: Chikara Kunisaki, MD, PhD, Hirotoshi Akiyama, MD, PhD, Masato Nomura, MD, PhD, Goro Matsuda, MD, PhD, Yuichi Otsuka, MD, PhD, Hidetaka Ono, MD, PhD, Yutaka Nagahori, MD, PhD, Hideo Hosoi, MD, PhD, Masazumi Takahashi, MD, PhD, Fumihiko Kito, MD, PhD, Hiroshi Shimada, MD, PhD

Published in: Annals of Surgical Oncology | Issue 5/2006

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Abstract

Background

Curative gastrectomy is a promising approach for the treatment of gastric cancer; however, the optimal extent of lymph node dissection for advanced cancer remains controversial. The aim of this multi-institutional study was to evaluate the feasibility of D3 gastrectomy (para-aortic lymph node dissection) for advanced gastric cancer. The surgical results of D2 and D3 gastrectomy (para-aortic lymph node dissection) were retrospectively compared.

Methods

A series of 580 advanced gastric cancer patients were registered between 1992 and 2000. Of these, 430 underwent D2 gastrectomy and 150 underwent D3 gastrectomy. Survival time, prognostic factors, postoperative morbidity/mortality, and pattern of recurrence were compared.

Results

There was no significant difference in survival time between D2 and D3 patients. However, the survival times of D3 patients with tumor diameters measuring 50 to 100 mm or with pN1 disease were significantly longer than those of the corresponding D2 patients. Analysis of the survival of patients with tumor diameters measuring 50 to 100 mm revealed that D3 gastrectomy conferred a survival advantage only to patients with pN2 disease. The incidence of lymphatic recurrence was lower in D3 patients with 50- to 100-mm tumors than in the corresponding D2 patients.

Conclusions

D3 gastrectomy might be beneficial in patients with advanced pN2 gastric cancer within the group with tumors measuring 50 to 100 mm. A randomized controlled trial of patients with 50- to 100-mm tumors should be performed to test the validity of this preliminary result.
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Metadata
Title
Comparison of Surgical Results of D2 Versus D3 Gastrectomy (Para-Aortic Lymph Node Dissection) for Advanced Gastric Carcinoma: A Multi-Institutional Study
Authors
Chikara Kunisaki, MD, PhD
Hirotoshi Akiyama, MD, PhD
Masato Nomura, MD, PhD
Goro Matsuda, MD, PhD
Yuichi Otsuka, MD, PhD
Hidetaka Ono, MD, PhD
Yutaka Nagahori, MD, PhD
Hideo Hosoi, MD, PhD
Masazumi Takahashi, MD, PhD
Fumihiko Kito, MD, PhD
Hiroshi Shimada, MD, PhD
Publication date
01-05-2006
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 5/2006
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/ASO.2006.07.015

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