title: Evaluation of D3/D4 lymph node dissection for patients with grossly N2 positive advanced gastric cancer.
abstract: OBJECTIVE
  Extended lymphadenectomy (D2) with complete resection of gastric cancer has been generally accepted as a standard treatment modality in Japan. However, the clinical evaluation of the superextended lymphadenectomy (D3/D4) for advanced type of gastric cancer has not been established.
  
  
  METHODS
  Eight hundred and twenty primary gastric cancer patients underwent gastric resection in our institute (1987-1997). Of those patients, 436 patients with more than t2 depth of cancer invasion underwent curative gastrectomy either with D2 (337 cases) or D3/D4 (99 cases). D3/D4 was performed for the cases in which metastasis was recognized in N2 lymph nodes with gross inspection at the time of operation.
  
  
  RESULTS
  There was no statistically significant survival advantage to the D3/D4 when comparing between the D2 and D3/D4 groups. However, the relative risk of death due to postoperative relapse in the D3/D4 showed a significantly lower hazard ratio than in the D2, in the Cox proportional-hazard model (0.67; 95% CI: 0.47-0.94). Patients receiving D3/D4 lymphadenectomy showed a better 5-year survival rate in stage IIIb than those with D2 (18.4% vs. 48.9%, p = 0.039). No statistically significant differences were found between the two groups as regards postoperative morbidity and mortality.
  
  
  CONCLUSIONS
  D3/D4 lymphadenectomy might be of therapeutic value for limited patients with advanced gastric cancer.
authors.affiliation: Department of Academic Surgery (M9), Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuou-ku, Chiba, 260-8670, Japan. gunjim9@med.m.chiba-u.ac.jp
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Gunji
authors.forename: Takao
authors.initials: T
authors.lastname: Suzuki
authors.forename: Susumu
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Seiji
authors.initials: S
authors.lastname: Hori
authors.forename: Hideki
authors.initials: H
authors.lastname: Hayashi
authors.forename: Hideaki
authors.initials: H
authors.lastname: Shimada
authors.forename: Hisahiro
authors.initials: H
authors.lastname: Matsubara
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nabeya
authors.forename: Takenori
authors.initials: T
authors.lastname: Ochiai
mesh_terms: D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome