title: Complications after extended (D2) and superextended (D3) lymphadenectomy for gastric cancer: analysis of potential risk factors.
abstract: BACKGROUND
  Very few studies from Western centers have compared D2 and D3 dissection in the surgical treatment of gastric cancer. The aim of the prospective observational study reported here was to analyze the postoperative outcome and potential risk factors for complications following D2 and D3 lymphadenectomy.
  
  
  METHODS
  A total of 330 consecutive patients, of which 251 submitted to D2 lymphadenectomy and 79 were treated by D3 lymphadenectomy, were enrolled in the study. Twenty potential risk factors for morbidity and mortality were studied by means of univariate and multivariate analysis.
  
  
  RESULTS
  Overall morbidity and mortality rates were 34% (111 patients) and 4% (14 patients), respectively. Abdominal abscess, anastomotic leakage, pleuropulmonary diseases and pancreatitis were the most commonly observed complications. No differences in morbidity, surgical morbidity, mortality rates and mean hospital stay between D2 and D3 lymphadenectomy were found. Multivariate analysis revealed that American Society of Anesthesiologists' (ASA) class II/III versus class I, perioperative blood transfusions, and low albumin serum levels were independent predictors of postoperative complications. Age, surgical radicality (R1/R2 vs. R0) and low albumin serum levels independently predicted mortality. Mortality rate was .5% in the 203 patients aged 75 years or younger who underwent curative surgery. Most of deaths were observed in patients older than 75 years with low albumin serum levels or treated by non-curative surgery.
  
  
  CONCLUSIONS
  D2 lymphadenectomy represents a feasible procedure associated to acceptable morbidity and mortality rates. In specialized centers, D3 lymphadenectomy may be performed without increasing the risk of postoperative complications and associated deaths in carefully selected patients. These techniques should be avoided in subgroups of patients with a high risk of postoperative mortality.
authors.affiliation: Department of Human Pathology and Oncology, Unit of Surgical Oncology, University of Siena, Siena, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marrelli
authors.forename: Corrado
authors.initials: C
authors.lastname: Pedrazzani
authors.forename: Alessandro
authors.initials: A
authors.lastname: Neri
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corso
authors.forename: Alfonso
authors.initials: A
authors.lastname: DeStefano
authors.forename: Enrico
authors.initials: E
authors.lastname: Pinto
authors.forename: Franco
authors.initials: F
authors.lastname: Roviello
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate
chemical_list: D012709:Serum Albumin