D2 vs D2 Plus Para-aortic Lymph Node Dissection for Advanced Gastric Cancer

Area of Science:

• Surgical Oncology
• Gastroenterology
• Oncology

Background:

• Gastric cancer is a significant global health concern requiring effective treatment strategies.
• Surgical intervention remains a cornerstone in managing gastric cancer, often necessitating interdisciplinary collaboration.

Purpose of the Study:

• To compare the safety and efficacy of standard D2 lymphadenectomy versus D2 lymphadenectomy plus para-aortic lymph node (PALN) dissection in patients with gastric cancer.
• To evaluate the impact of D2 plus PALN dissection on postoperative complications, morbidity, mortality, and long-term survival.

Main Methods:

• A retrospective study involving 162 patients with gastric cancer over a ten-year period.
• Patients were divided into two groups: D2 lymphadenectomy (n=107) and D2 lymphadenectomy plus PALN dissection (n=55).
• Outcomes assessed included length of hospital stay, operative mortality, complication rates, and survival rates.

Main Results:

• Operative mortality was 5% and similar between groups (D2: 8/107, D2+PALN: 0/55).
• Complication rates were comparable: 18% in the D2 group and 17% in the D2+PALN group.
• While overall survival was similar, D2 plus PALN dissection demonstrated improved survival for patients with T3-T4 tumors and stage IIIA-IIIB disease.

Conclusions:

• D2 plus PALN dissection is a safe procedure for advanced gastric cancer, comparable to standard D2 dissection in terms of morbidity and mortality.
• For advanced gastric cancer stages (IIIA-IIIB), D2 plus PALN dissection is recommended to enhance survival rates.
• Depth of invasion, number of positive lymph nodes (PLN), PLN/total lymph node ratio (TLN), tumor stage, and lymph node dissection (LND) are identified as prognostic variables.