Gastrectomy with D2 lymph node dissection in gastric cancer: a retrospective study at a single institution

The purpose of this study was to clarify the clinicopathological characteristics of gastric cancer with lymph node (LN) dissection and the significance of D2 dissection by investigating surgical techniques and prognosis. Three hundred ninety patients with early cancer and 310 with advanced cancer underwent gastrectomy with D1 or D2 dissection, based on the presence or absence of LN metastasis determined pre- and intraoperatively. LN metastasis occurred in 10.5% of early gastric cancer patients, and several cases of advanced cancer were found to have N2 or more advanced metastasis. The pre- and intraoperative macroscopic findings accorded with histological grade of LN metastasis in 69.5% of early cancers and in 56.5% of advanced cancer patients. The false negativity rate was 6.8% in early cancer, 19.4% in advanced cancer, and 8.4% as a whole. Death was operation-related in only two cases and the operative mortality rate was low (0.29%). The 5-year survival rates in early and advanced gastric cancer were 95.8% and 67.6% in the D1 groups, respectively, and 100% and 89.5% in the D2 groups, respectively. Survival was better in the D2 groups than in the D1 groups (P < 0.0001 for early cancer, P = 0.0279 for advanced cancer). D2 dissection should be conducted positively for patients with LN metastasis.