title: Results of D2 gastrectomy for gastric cancer: lymph node chain dissection or multiple node resection?
abstract: BACKGROUND
  Eastern literature is remarkable for presenting survival rates for surgical treatment of gastric adenocarcinoma superior to those presented in western countries.
  
  
  OBJECTIVE
  To analyze the long-term result after D2 gastrectomy for gastric cancer.
  
  
  METHODS
  Two hundred seventy four underwent gastrectomy with D2 lymph node dissection as exclusive treatment. The inclusion criteria were: 1) lymph node removal according to Japanese standardized lymphatic chain dissection; 2) potentially curative surgery described in medical records as D2 or more lymph node dissection; 3) tumoral invasiveness of gastric wall restricted to the organ (T1-T3); 4) absence of distant metastasis (N0-N2/M0); 5) a minimum of five years follow-up. Clinical pathological data included sex, age, tumor location, Borrmann's macroscopic tumor classification, type of gastrectomy, mortality rates, hystological type, TNM classification and staging according to UICC TNM 1997.
  
  
  RESULTS
  Total gastrectomy was performed in 77 cases (28.1%) and subtotal gastrectomy in 197 (71.9%). The tumor was located in the upper third in 28 cases (10.2%), in the middle third in 53 (19.3%), and in the lower third in 182 (66.5%). Among patients that had their Borrmann's classification assigned, five cases (1.8%) were BI, 34 (12.4%) BII, 230 (84.0%) BIII and 16 (5.9%) BIV. Tumors were histologically classified as Laurén intestinal type in 119 cases (43.4%) and as diffuse type in 155 (56.6%). According to UICC TNM 1997 classification, early gastric cancer (T1) was diagnosed in 68 cases (24.8 %); 51 (18.6%) were T2, and 155 (56.6%) were T3. No lymph node involvement (N0) was observed in 129 cases (47.1%), whereas 100 (36.5%) were N1 (1-6 lymph nodes), and 45 (16.4%) were N2 (7-15 lymph nodes).The median number of lymph nodes dissected was 35. The overall long-term (five-year) survival rate, for stages I to IIIb was 70.4%.
  
  
  CONCLUSIONS
  Digestive surgeons must be stimulated in performing D2 gastrectomies to avoid wasting the only treatment to gastric adenocarcinoma that has proven to be efficient up to this days. It must be emphasized that standardized lymph nodes dissection according to tumor location is more important that only the number of removed nodes.
authors: University of São Paulo School of Medicine, Department of Gastroenterology, Digestive Surgery Division, São Paulo, SP, Brasil. brunozilb@uol.com.br
authors: Bruno
authors: B
authors: Zilberstein
authors: Donato Roberto
authors: DR
authors: Mucerino
authors: Osmar Kenji
authors: OK
authors: Yagi
authors: Ulysses
authors: U
authors: Ribeiro-Junior
authors: Fabio Pinatel
authors: FP
authors: Lopasso
authors: Claudio
authors: C
authors: Bresciani
authors: Carlos Eduardo
authors: CE
authors: Jacob
authors: Brian Guilherme Monteiro Marta
authors: BG
authors: Coimbra
authors: Ivan
authors: I
authors: Cecconello
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult