D2 lymph node dissection improves staging in patients with gastric adenocarcinoma

Debate continues over the recommended extent of routine lymphadenectomy for gastric cancer. Although evidence of improved locoregional control with extended dissection accumulates, understaging and stage migration continue to confound the issue. Our objective was to determine whether D2 lymph node dissection improves staging compared with D1 in patients with gastric adenocarcinoma. We performed a retrospective study of 79 consecutive patients who underwent resection of gastric adenocarcinoma at a single institution. The American Joint Committee on Cancer (AJCC) 7th edition (2010) was used for TNM staging. Twenty-seven patients (34%) underwent D2 lymphadenectomy; 52 underwent D1 lymphadenectomy. There was no significant difference in age, gender, or operation. Significantly more lymph nodes were removed with a D2 than a D1 lymphadenectomy (mean, 26 vs 9; P < 0.0001). Significantly more patients had at least 15 nodes removed in the D2 cohort (85 vs 17%, P < 0.001). Within the D2 cohort, nine patients (39%) demonstrated additional lymph node metastases on extended dissection. This altered nodal status in five patients (20%) and altered TNM stage in four patients (16%). There was no significant difference in perioperative morbidity. D2 lymphadenectomy significantly increases node retrieval and AJCC compliance for gastric adenocarcinoma, resulting in improved staging.