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Extended lymph-node dissection for gastric cancer.

J J Bonenkamp1, J Hermans, M Sasako

  • 1Department of Surgery, Leiden University Medical Center, The Netherlands.

The New England Journal of Medicine
|March 25, 1999
PubMed
Summary
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In gastric cancer surgery, extended (D2) lymph-node dissection showed higher complications and mortality than limited (D1) dissection, with similar survival rates. Routine D2 dissection is not supported by these Dutch trial results.

Area of Science:

  • Oncology
  • Surgical Oncology
  • Gastroenterology

Background:

  • Gastric cancer treatment relies on curative resection.
  • The necessity of extended (D2) versus limited (D1) lymph-node dissection remains debated.
  • Japanese guidelines recommend D2 dissection, while its efficacy in Western populations is less clear.

Purpose of the Study:

  • To compare D1 and D2 lymph-node dissection in gastric cancer surgery.
  • To evaluate differences in morbidity, postoperative mortality, survival, and relapse rates.
  • To provide evidence for optimal surgical practice in gastric cancer.

Main Methods:

  • A randomized trial involving 996 patients across 80 Dutch hospitals.
  • Comparison of D1 (limited) versus D2 (extended) lymph-node dissection.

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  • Quality control included surgical instruction, supervision, and pathological result monitoring.

    • Main Results:

    • D2 dissection resulted in significantly higher complication rates (43% vs. 25%) and postoperative mortality (10% vs. 4%).
    • Five-year survival rates were comparable between D1 (45%) and D2 (47%) groups.
    • For R0 resections, the 5-year relapse risk was 43% for D1 and 37% for D2, with no statistically significant difference.

    Conclusions:

    • The study does not support the routine use of D2 lymph-node dissection for gastric cancer in Dutch patients.
    • D1 lymph-node dissection appears to be a safer alternative with comparable oncological outcomes in this population.
    • Further research may be needed to identify patient subgroups who might benefit from D2 dissection.