title: Functional outcomes after extended surgery for gastric cancer.
abstract: BACKGROUND
  Extended gastrectomy with para-aortic nodal dissection (PAND) or thorough dissection of mediastinal nodes using a left thoracoabdominal (LTA) approach is an alternative to D2 lymphadenectomy, with variable postoperative results.
  
  
  METHODS
  Two randomized controlled trials have been conducted to compare D2 lymphadenectomy alone (263 patients) versus D2 lymphadenectomy plus PAND (260), and the abdominal-transhiatal (TH) approach (82) versus the LTA approach (85), in patients with gastric cancer. Prospectively registered secondary endpoints bodyweight, symptom scores and respiratory function were evaluated in the present study.
  
  
  RESULTS
  Bodyweight was comparable after D2 and D2 plus PAND, but higher after TH than after LTA procedures at 1 and 3 years. At 1- and 3-year follow-up symptom scores were comparable between D2 and D2 plus PAND. A LTA approach resulted in significantly worse scores than a TH approach in terms of meal volume, return to work, incisional pain and dyspnoea up to 1 year. The decrease in vital capacity was significantly greater after LTA than TH procedures up to 6 months.
  
  
  CONCLUSIONS
  Bodyweight and postoperative symptoms were not affected by adding PAND to a D2 procedure. A LTA approach aggravated weight loss, symptoms and respiratory functions compared with a TH approach.
authors.affiliation: Department of Surgery, Osaka National Hospital, Osaka, Japan. ykurokawa@gesurg.med.osaka-u.ac.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Kurokawa
authors.forename: M
authors.initials: M
authors.lastname: Sasako
authors.forename: T
authors.initials: T
authors.lastname: Sano
authors.forename: T
authors.initials: T
authors.lastname: Shibata
authors.forename: S
authors.initials: S
authors.lastname: Ito
authors.forename: A
authors.initials: A
authors.lastname: Nashimoto
authors.forename: A
authors.initials: A
authors.lastname: Kurita
authors.forename: T
authors.initials: T
authors.lastname: Kinoshita
mesh_terms: D000328:Adult; D000368:Aged; D001835:Body Weight; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D008482:Mediastinum; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012120:Respiration Disorders / Q000209:etiology; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome