Evaluation of D3/D4 lymph node dissection for patients with grossly N2 positive advanced gastric cancer.
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.
Gunji
Yoshio
Y
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
Suzuki
Takao
T
Kobayashi
Susumu
S
Hori
Seiji
S
Hayashi
Hideki
H
Shimada
Hideaki
H
Matsubara
Hisahiro
H
Nabeya
Yoshihiro
Y
Ochiai
Takenori
T
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