[Effects of systematic lymphadenectomy on length of survival in patients with gastric carcinoma].
BACKGROUND
In the last few years there have been arguments between the Japanese and West European surgeons about benefits of systematic lymphadenectomies in surgery of gastric cancer. In this paper we would like to point out effects of systematic lymphadenectomies on survival of patients with gastric carcinoma.


METHODS
This investigation included two groups of patients. The first group of 126 patients with gastric carcinoma underwent peritumor lymphadenectomy D1. The second group of 114 patients with gastric carcinoma underwent more radical types of lympadenectomy (D2, D2+, D3). Survival analysis included investigation of the following: 1. depth of tumor invasion, 2. metastatic involvement of the lymph nodes 3. tumor stage, 4. tumor recurrence.


RESULTS
Most of examined patients presented with invasion and serosal and subserosal penetration (about 75% in both groups). More than 42% of lymph nodes had metastases and patients with systematic lymphadenctomy had better survival. Patients without subserosal invasion did not have metastatic lymph nodes in II, III, IV drianaged groups. There was no difference in regard to length of survival between the two analyzed group. 5-year survival rate was highest in stage I of gastric carcinoma (86%), but in stage IV 5-year survival rate was only 3.8%. Local recurrence (26%) and lymph node metastases (53%) were common causes of tumor recurrence in group with peritumor lymphadenectomy. In all groups of patients with advanced gastric cancer patients undergoing systematic lymphadenectomy presented with higher survival rate.


CONCLUSIONS
Patients with advanced gastric cancer presented with higher number of metastatic lymph nodes in III and IV drainaged groups. In this stage systematic lympadenectomy played the main role. In the group of early gastric cancer there were no patients with metastatic lymph nodes in drainaged groups.


CONCLUSIONS
D2 lympahedenectomy is a standard procedure for a great number of patients with gastric carcinoma, with high survival rate. Only in the group of advanced gastric cancer, patients undergoing more radical types of lymphadenectomies (D2+, D3) presented with better survival rates.
Klinika za hirurgiju, KBC "Dr Dragisa Misović", Beograd. deves@yubc.net
Dejan
D
Stevanović
Dragan
D
Radovanović
Ivan
I
Pavlović
Petar
P
Kostić
D002277:Carcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015996:Survival Rate