Gastrectomy with Extended Lymphadenectomy: a North American Perspective

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Gastric cancer surgery often involves lymphadenectomy to remove cancerous lymph nodes.
• Extended (D2) lymphadenectomy has demonstrated oncologic benefits in East Asian studies.
• Western centers have hesitated to adopt D2 dissection due to concerns about morbidity and mortality.

Purpose of the Study:

• To evaluate the safety and efficacy of D2 lymphadenectomy for gastric cancer in a high-volume North American center.
• To compare the outcomes of D2 dissection versus traditional D1 dissection in gastric cancer patients.

Main Methods:

• A retrospective review of a prospectively entered database of gastrectomy for cancer patients (2005-2016) at a North American referral center.
• Inclusion criteria excluded wedge resections, thoracoabdominal approaches, emergency surgeries, palliative operations, and non-adenocarcinoma cases.
• Data analysis compared postoperative complications, anastomotic leaks, mortality, pathological stage, lymph node yield, and complete resection rates between D1 and D2 groups.

Main Results:

• Of 175 eligible patients, 141 (80%) underwent D2 dissection. No significant differences were observed in postoperative complications (44% D1 vs. 42% D2), anastomotic leaks (6% D1 vs. 5% D2), or 30-day mortality (6% D1 vs. 2% D2).
• D2 dissection was associated with higher pathological stage (72% > stage 1 vs. 38% > stage 1) and greater lymph node yield (median 30 vs. 14).
• The complete resection (R0) rate was similar between D1 (98%) and D2 (92%) groups. Laparoscopic D2 dissection resulted in shorter hospital stays (6 vs. 9 days) with equivalent oncologic outcomes compared to open D2.

Conclusions:

• D2 lymphadenectomy, performed via open or laparoscopic approaches, is a safe and effective oncologic procedure for gastric cancer in high-volume North American centers.
• The study supports D2 dissection, demonstrating equivalent complication rates and superior lymph node yield compared to D1 dissection.
• Laparoscopic D2 dissection offers potential benefits, including reduced length of stay, while maintaining oncologic efficacy.