title: Modified radical lymphadenectomy (D1.5) for T2-3 gastric cancer.
abstract: BACKGROUND
  The operative mortality in gastric cancer surgery has been reported to be higher with D2 lymphadenectomy than with D1 in the West. The modified radical lymphadenectomy (D1.5) may be safer than D2 under these circumstances. This study was aimed to determine whether D1.5 would deteriorate long-term survival as compared with D2.
  
  
  METHODS
  Since the concept of the extent of lymphadenectomy varied among the surgeons, 461 patients who underwent curative gastrectomy for T2-4 gastric adenocarcinoma were retrospectively categorized into three groups according to the surgeon: D1 with dissection along the left gastric and common hepatic arteries (D1.5); lymphadenectomy between D1.5 and D2; D2 or more extended dissection.
  
  
  RESULTS
  No differences were found in the survival rates among the three groups within each of the T2a, T2b, and T3 categories. According to a multivariate analysis using Cox's proportional hazard model, the classification according to the surgeons had no survival impact (p>0.8).
  
  
  CONCLUSIONS
  D1.5 lymphadenectomy resulted in a survival rate that was almost equal to that of D2. The use of D1.5 instead of D2 can be an attractive option to be compared with D1 in future trials.
authors.affiliation: Department of Surgery I, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, 359-8513, Japan. ichiku24@me.ndmc.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Ichikura
authors.forename: Kentaro
authors.initials: K
authors.lastname: Chochi
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Sugasawa
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Mochizuki
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate