Surgery for Gastric Cancer: A 1154 Patients Experience

Background and Purpose: The major controversy for surgical treatment of gastric cancer now is in regard to the extent of lymph node dissection necessary to achieve a best chance of cure and an accurate staging. This study was aimed to compare the difference in survival and postoperative mortality between extended lymphadenectomy and limited lymphadenectomy. Methods: We retrospectively assessed 1154 patients who underwent total or subtotal gastrectomy for primary gastric cancer in the department of gastrointestinal surgery of Renai hospital between 1974 and 2000. 901 of them were treated with potentially curative resection. The patients were divided into three groups (group A: R0D2; group B: R0 D1 or D1+; group C: noncurative). The clinical and pathologic characteristics and survival difference were analyzed. Results: Five-year survival rate for all patients was 47.4 %. The 5-year survival rates for the patients of group A, B and C were 61.6%, 42.1% and 1.7%, respectively. The 5-year survival rates related to stage were: Stage Ⅰa, 95.5%; Stage Ⅰb78.4%; Stage Ⅱ, 64.5%; Stage Ⅲ, 29.9%; Stage Ⅳ, 4.8%. Postoperative hospital mortality totaled 2.3% (26/1154). The rate for group A patients was 1.5% (12/801). Postoperative hospital mortality rates were 3.9% (4/103) for group B patients and 4% (10/250) for group C patients. Conclusion: Radical gastrectomy with extended lymph node dissection in this study had survival rates similar to the Japanese investigations with a low postoperative mortality. Our results showed that extended (D2) gastrectomy had a superior survival result than the limited lymphadenectomy and should be the better option for advanced gastric cancer that is potentially resectable.