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Prophylactic lymph node dissection for early gastric cancer invading submucosa
Yoichi Ikeda1, Motonori Saku, Hirofumi Kawanaka
1Department of Surgery and Clinical Research Institute, National Kyushu Medical Center, Fukuoka, Japan. yoikeda@qmed.hosp.go.jp
Hepato-Gastroenterology
|May 18, 2004
Summary
For early gastric cancer invading submucosa without lymph node metastasis, limited D2 lymph node dissection is effective. This approach minimizes dissection while maintaining high survival rates, similar to standard D2 procedures.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Clinical Research
Background:
- D2 lymph node dissection is standard for early gastric cancer with submucosal invasion and no lymph node metastasis.
- Investigating less extensive prophylactic lymph node dissection is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of limited D2 lymph node dissection compared to standard D2 dissection in early gastric cancer patients.
- To determine if minimizing lymph node dissection is safe and effective when lymph node metastasis is absent.
Main Methods:
- Analysis of 404 early gastric cancer patients with submucosal invasion who underwent gastrectomy between 1979 and 1998.
- Comparison of postoperative survival rates between standard D2 dissection and limited D2 dissection (nodes No. 7, 8, and 9).
Main Results:
- Lymph node metastasis was found in 52 patients (group 1) and 17 patients (group 2).
- Of those with metastasis in group 2 nodes, 82.4% had it confined to nodes No. 7, 8, and 9.
- Five-year survival rates were 94.4% for limited D2 and 97.3% for standard D2 dissection in patients without lymph node metastasis.
Conclusions:
- Limited D2 lymph node dissection is an appropriate and effective approach for early gastric cancer invading the submucosa without lymph node metastasis.
- Minimizing the extent of prophylactic lymph node dissection is feasible and safe in selected early gastric cancer cases.