title: Prognostic significance of distal subtotal gastrectomy with standard D2 and extended D2 lymphadenectomy for locally advanced gastric cancer.
abstract: This study was conducted to investigate prognosis and survival of patients undergoing distal subtotal gastrectomy with D2 and D2+ lymphadenectomy for patients with locally advanced gastric cancer. Overall survival rates of 416 patients with locally advanced gastric cancer were compared between D2 and D2+ lymphadenectomy. Univariate analysis and multivariate analysis was used to identify significant prognostic factors correlated with LN metastasis and prognosis. Univariate analysis identified tumor size, lymphatic vessel invasion, pT stage, pN stage, TNM stage, locoregional recurrence, and distant recurrence, to significantly correlate with prognosis; Tumor size, LVI, and pT stage were identified as independent factors correlating with LN metastasis. Multivariate analysis demonstrated that tumor size, pT stage, pN stage, locoregional recurrence, and distant recurrence were independent prognostic factors; Tumor size and pT stage were independent prognostic factors predicting LN metastasis. When comparing 5-year survival rates of patients who underwent D2 and D2+ lymphadenectomy, as stratified by pT stage and pN stage, a significant difference was found in pN3 patients, but not for pT2-4 and pN0-2 patients, or the patient cohort as a whole. In conclusion, D2 lymphadenectomy for patients with locally advanced gastric cancer undergoing distal subtotal gastrectomy was recommended, especially in eastern Asia.
authors.affiliation: Department of Gastrointestinal Surgery, the Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
authors.forename: Chun-Dong
authors.initials: CD
authors.lastname: Zhang
authors.affiliation: Department of Gastrointestinal Surgery, the Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
authors.forename: Ming-Yang
authors.initials: MY
authors.lastname: Shen
authors.affiliation: Department of Gastrointestinal Surgery, the Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
authors.forename: Jia-Kui
authors.initials: JK
authors.lastname: Zhang
authors.affiliation: Department of Gastrointestinal Surgery, the Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
authors.forename: Fei-Long
authors.initials: FL
authors.lastname: Ning
authors.affiliation: Department of Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning, China.
authors.forename: Bao-Sen
authors.initials: BS
authors.lastname: Zhou
authors.affiliation: Department of Gastrointestinal Surgery, the Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.|Cancer Research Institute, China Medical University, Shenyang, Liaoning, China.|Cancer Center, the Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
authors.forename: Dong-Qiu
authors.initials: DQ
authors.lastname: Dai
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed