Complications of gastrectomy with lymphadenectomy in gastric cancer.
BACKGROUND
Currently, gastrectomy and extended lymphadenectomy (LN) is the treatment of choice for gastric cancer. Although a survival rate benefit of D2 LN compared to D1 LN has been shown, the D2 LN procedure is not fully employed, due to possible higher morbidity and mortality rates. These higher rates are being questioned in more recent series, in which D1 and D2 LN complication rates have been similar. The aim of this study was to analyze the immediate postoperative complications of patients submitted to total or subtotal gastrectomy with D1 or D2 LN (according to the Japanese guidelines for gastric cancer) at the Gastrointestinal Surgery Division of the Medical School of São Paulo University, between January 2001 and April 2003.


METHODS
One hundred consecutive patients were studied; 61 were men and 39, women. Total gastrectomy was performed in 52 patients (13 with D1 LN and 39 with D2 LN), and subtotal gastrectomy was performed in 48 (11 with D1 LN and 37 with D2 LN). Total or subtotal gastrectomy with D1 or D2 LN was performed according to the tumor extent and histological classification (Lauren's diffuse or intestinal type), considering the patient's general condition and the gastric cancer stage. Roux-en-Y reconstruction was performed in almost all patients.


RESULTS
No difference was observed regarding complications and mortality related to the extent of the gastrectomy. Although morbidity was higher in the D1 group, no significant difference was observed. Mortality was higher in the D1 group, and this was probably related to their poor surgical condition and more advanced tumors.


CONCLUSIONS
According to these results, it appears that total or subtotal gastrectomy with D2 LN in gastric cancer treatment, performed according to the Japanese guidelines, can be considered a safe procedure, with acceptable morbidity and mortality, when performed by a trained surgical team.
Zilberstein
Bruno
B
Department of Gastroenterology, University of São Paulo School of Medicine, Av 9 de Julho 4440, São Paulo, SP, 01406-100, Brazil.
Martins
Bruno da Costa
BC
Jacob
Carlos Eduardo
CE
Bresciani
Cláudio
C
Lopasso
Fábio Pinatel
FP
de Cleva
Roberto
R
Pinto Junior
Paulo Engler
PE
Junior
Ulysses Ribeiro
UR
Perez
Rodrigo Oliva
RO
Gama-Rodrigues
Joaquim
J
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007564:Japan; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*