title: Super-extended (D3) lymphadenectomy in advanced gastric cancer.
abstract: OBJECTIVE
  To analyze our experience with D3 lymphadenectomy in the treatment of advanced GC with specific reference to post-operative morbidity and mortality, incidence of para-aortic node (PAN) metastases, and long-term prognosis.
  
  
  METHODS
  Short- and long-term results of D3 lymphadenectomy were analyzed in 286 patients with advanced GC.
  
  
  RESULTS
  PAN metastases were demonstrated in 37 patients. PAN involvement was significantly higher in upper third tumours (29%) compared to middle and lower third (7%; P < 0.001). Eighty patients developed post-operative complications, being pulmonary disorders (6%), abdominal abscesses (4.5%) and pancreatic fistulas (3%) the most frequently observed. In-hospital mortality was 2%. Overall 5-year survival rate for R0 pT2-4 patients was 52%. When considering survival in relation to nodal involvement, both pN3 and non-regional lymph node metastases (M1a) patients showed a chance of long-term survival: 5-year survival was 31% for pN3 and 17% for M1a cases. Furthermore, the 5-year survival rate was remarkably high (about 60%) even in pN2 and pN3 subsets when no serosal invasion (pT2) was demonstrated.
  
  
  CONCLUSIONS
  D3 lymphadenectomy could be further explored in specialized centers for curative surgery of advanced GC, especially for upper third tumours, providing that an acceptable morbidity and no increase in mortality can be offered.
authors.affiliation: Department of Human Pathology and Oncology, Unit of Surgical Oncology, University of Siena, ITT, Istituto Toscano Tumouri, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Roviello
authors.forename: C
authors.initials: C
authors.lastname: Pedrazzani
authors.forename: D
authors.initials: D
authors.lastname: Marrelli
authors.forename: A
authors.initials: A
authors.lastname: Di Leo
authors.forename: S
authors.initials: S
authors.lastname: Caruso
authors.forename: S
authors.initials: S
authors.lastname: Giacopuzzi
authors.forename: G
authors.initials: G
authors.lastname: Corso
authors.forename: G
authors.initials: G
authors.lastname: de Manzoni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods* / Q000706:statistics & numerical data; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*