Short-Term Outcome in Patients Undergoing Gastrectomy with D2 Lymphadenectomy for Carcinoma Stomach

The safety and feasibility of D2 lymphadenectomy for gastric cancer in Western patients have been shown by Italian Gastric Cancer Study Group (IGCSG). In our center at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), we have been doing D1 lymphadenectomy all these years. Hence, this study was taken up to assess the feasibility of gastrectomy with D2 lymphadenectomy in patients with gastric cancer at JIPMER, Puducherry, India. Of the 148 carcinoma stomach patients explored, a total of 52 patients (35.13%) underwent resection with D1 (34 patients) or D2 (18 patients) lymphadenectomy, who formed the study groups. Patients were admitted and investigated by upper gastrointestinal endoscopy (UGIE) and other appropriate investigations including contrast-enhanced computed tomography (CECT) of the abdomen. Eligible patients had no serious comorbid cardiorespiratory disease that would preclude a safe D2 procedure. Two-third of the patients in both the groups belonged to the 50-75 age group. The mean number of nodes dissected was 6.44 ± 5.3 in the gastrectomy with D1 lymphadenectomy group versus 21.67 ± 5.3 in the gastrectomy with D2 lymphadenectomy group. There was no difference in the intraoperative blood loss, the number of units of blood transfused and the duration of surgery between D1 and D2 lymphadenectomy in our study. There was no difference between the postoperative stay and overall stay between the D1 and D2 lymphadenectomy. There was no significant difference between the overall morbidity and mortality or when the surgical complications were analysed individually. Intraoperative blood loss, the number of units of blood required for transfusion and the duration of surgery were not increased in D2 lymphadenectomy. The number of lymph nodes harvested was significantly more in D2 lymphadenectomy that resulted in a better staging. Postoperative morbidity or mortality in patients undergoing D2 lymphadenectomy was the same as in D1 lymphadenectomy. Hence, gastrectomy with D2 lymphadenectomy could be done safely.