Functional outcomes after extended surgery for gastric cancer

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Gastric Cancer Treatment

Background:

• Extended gastrectomy with para-aortic nodal dissection (PAND) or left thoracoabdominal (LTA) approach offers an alternative to D2 lymphadenectomy for gastric cancer.
• Postoperative results of these extended procedures can be variable.

Purpose of the Study:

• To compare D2 lymphadenectomy alone versus D2 plus PAND in gastric cancer patients.
• To compare abdominal-transhiatal (TH) versus LTA approaches in gastric cancer surgery.
• To evaluate the impact of these surgical approaches on body weight, symptom scores, and respiratory function.

Main Methods:

• Two randomized controlled trials were conducted.
• Trial 1: D2 lymphadenectomy (263 patients) vs. D2 plus PAND (260 patients).
• Trial 2: Abdominal-transhiatal (TH) approach (82 patients) vs. LTA approach (85 patients).
• Secondary endpoints including body weight, symptom scores, and respiratory function were prospectively evaluated.

Main Results:

• Body weight was comparable between D2 and D2 plus PAND groups at 1 and 3 years.
• Body weight was higher after TH compared to LTA procedures at 1 and 3 years.
• Symptom scores were comparable between D2 and D2 plus PAND groups at 1 and 3 years.
• The LTA approach resulted in significantly worse outcomes (meal volume, return to work, pain, dyspnoea) than the TH approach up to 1 year.
• A greater decrease in vital capacity was observed after LTA compared to TH procedures up to 6 months.

Conclusions:

• Adding PAND to D2 lymphadenectomy does not adversely affect body weight or postoperative symptoms in gastric cancer patients.
• The LTA surgical approach leads to significantly worse body weight, symptom scores, and respiratory function compared to the TH approach.