Extended lymphadenectomy (D2) in patients with early gastric cancer.
OBJECTIVE
To investigate the survival benefit of extended lymphadenectomy (D2) in EGC patients in one European Institution.


METHODS
A review was made of our prospective gastric database from January 1980 to December 2001. Of 527 patients with primary gastric adenocarcinoma, 119 with EGC underwent potentially curative resection (R0) with D2 lymphadenectomy.


RESULTS
There were two post-operative deaths. Of the 117 evaluable cases, 96 were classified as N0 and 21 as N+, with metastases in the perigastric lymph nodes (level 1) in 13, and beyond this site (level 2) in eight. Five-year survival was 85.9 and 83.0% in N0 and N+ patients, respectively. During a median follow-up of 90 months, five of the eight patients with level 2 metastases died of recurrent disease and three were alive. The estimated survival benefit for 119 patients with EGC was 2.5% (3/119 cases).


CONCLUSIONS
In patients with EGC, metastases to level 2 are rare. Our results indicate that D2 lymphadenectomy has a limited survival benefit and that in these cases a less extensive lymphadenectomy (D1) could be performed.
Nitti
D
D
Department of Oncological and Surgical Sciences, University of Padova, Padova, Italy. donatto.nitti@unipd.it
Marchet
A
A
Mammano
E
E
Ambrosi
A
A
Belluco
C
C
Mencarelli
R
R
Maino
M
M
Marconato
G
G
Farinati
F
F
Lise
M
M
D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011446:Prospective Studies; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome