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Related Experiment Videos

D2 or not D2? The gastrectomy question.

Wyn G Lewis1, Paul Edwards, Jonathan D Barry

  • 1Department of Surgery, Royal Gwent Hospital, Cardiff Road, Newport, NP20 2UB, UK.

Gastric Cancer : Official Journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association
|May 22, 2002
PubMed
Summary
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Modified D2 gastrectomy improves gastric cancer survival without increasing complications or mortality compared to D1 gastrectomy. Specialist surgeons performing this procedure achieve better outcomes for patients with curable cancers.

Area of Science:

  • Surgical Oncology
  • Gastrointestinal Surgery
  • Cancer Research

Background:

  • Radical D2 gastrectomy offers the best reported long-term survival for gastric cancer.
  • European studies show higher D2 gastrectomy complication rates without survival benefit compared to D1 gastrectomy.
  • This study compares modified D2 gastrectomy by specialists with conventional D1 gastrectomy by general surgeons in the UK.

Purpose of the Study:

  • To compare the outcomes of modified D2 gastrectomy versus conventional D1 gastrectomy for gastric cancer.
  • To evaluate operative mortality, postoperative complications, and long-term survival.
  • To assess the impact of specialist versus general surgical expertise.

Main Methods:

  • A historical control study comparing two groups of gastric cancer patients.

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  • Group 1: 50 patients underwent D1 resection by general surgeons.
  • Group 2: 72 patients underwent modified D2 resection by specialist surgeons.

    • Main Results:

    • Among 122 curable cases, D2 gastrectomy had lower operative mortality (8.3% vs 12%) and fewer complications (28% vs 36%).
    • Five-year survival was significantly higher after D2 (56%) compared to D1 (11%) (P < 0.00001).
    • Disease stage and lymphadenectomy level were independent predictors of survival.

    Conclusions:

    • Modified D2 gastrectomy by specialist surgeons improves survival for R0 resections.
    • This approach does not increase operative morbidity or mortality compared to D1 gastrectomy.
    • Specialist expertise is crucial for successful D2 gastrectomy outcomes.