title: Is D2 lymph node dissection necessary for early gastric cancer?
abstract: BACKGROUND
  The objective of this study was to clarify a survival benefit of D2 lymphadenectomy in patients with early gastric carcinoma (GC).
  
  
  METHODS
  A retrospective study was conducted to examine the incidence of metastasis to level 2 lymph nodes, the causes of postoperative death, and the mode of recurrence in 1041 patients who had early GC and underwent D2 lymphadenectomy with curative intent.
  
  
  RESULTS
  Postoperative mortality occurred in 129 (12.4%) of 1041 patients, 6 patients (.6%) died of surgical complications, 108 (10.2%) died of diseases other than cancer, and 16 (1.5%) died of recurrence. Hematogenous metastasis was the major mode of recurrence (56.3% of recurrences). The incidence of metastasis to level 2 nodes was 2.5% (26 of 1041 patients, 18 of whom were alive). Thus, the estimated survival benefit of radical lymphadenectomy for patients with early GC was calculated to be 1.7% (18 of 1041 patients).
  
  
  CONCLUSIONS
  D2 lymphadenectomy in patients with early GC had little survival benefit because (1) metastasis to level 2 nodes was rare, (2) most causes of death were not related to the tumor, and (3) more than half the recurrences were hematogenous. Use of radical lymphadenectomy for early GC should be limited.
authors: Department of Gastrointestinal Surgery, Kanagawa Cancer Center Hospital, Yokohama, Japan. yoshikaw@yc5.so-net.ne.jp
authors: Takaki
authors: T
authors: Yoshikawa
authors: Akira
authors: A
authors: Tsuburaya
authors: Osamu
authors: O
authors: Kobayashi
authors: Motonori
authors: M
authors: Sairenji
authors: Hisahiko
authors: H
authors: Motohashi
authors: Yoshikazu
authors: Y
authors: Noguchi
mesh_terms: D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome