[Extensive lymph node dissection in stomach cancer? Initial results of the Dutch Stomach Cancer Study]

The five-year survival rate after curative resection for gastric cancer is higher in Japan (62%) than in the Netherlands (30%). In Japan, extensive D2 resection surgery is performed, in the Netherlands D(1) resection in which only the perigastric lymph nodes are removed. In a large prospective randomised trial, surgical departments of 80 Dutch hospitals compared the results of both resection types. A Japanese surgeon gave instruction in the D2 technique. D2 patients suffered more complications than D(1) patients and hospital mortality was 10% as against 4%. Demographic characteristics and concomitant morbidity might explain these differences. A change in current therapy is not advised at present. However, the surgical protocols and standards developed in connection with the trial reduced the overall death rate and morbidity of surgical treatment of gastric cancer in the Netherlands.