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Gastric carcinoma: does lymph node dissection alter survival?

H J Wanebo1, B J Kennedy, D P Winchester

  • 1Roger Williams Medical Center, Division of Surgical Oncology, Brown University Providence, RI 02908, USA.

Journal of the American College of Surgeons
|December 1, 1996
PubMed
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Extragastric lymph node dissection (D2) in gastric cancer surgery did not improve survival rates in patients with curative resections. Further research is needed to clarify the benefits of D2 node dissection for gastric carcinoma.

Area of Science:

  • Oncology
  • Surgical Oncology
  • Gastroenterology

Background:

  • Japanese studies suggest survival benefits for extragastric lymphadenectomy (D2 node dissection) in gastric cancer.
  • However, randomized trial data remain inconclusive or unsupportive of this approach.
  • This study evaluates the impact of extragastric node dissection on survival in gastric carcinoma patients undergoing curative resection.

Purpose of the Study:

  • To assess the association between extragastric lymph node dissection and survival outcomes.
  • To compare survival in patients with and without N2 node dissection after curative gastric cancer resection.

Main Methods:

  • Analysis of a prospectively gathered database of 18,346 gastric carcinoma cases from the American College of Surgeons.
  • Subgroup analysis of 3,804 patients with curatively resected gastric carcinoma and >5-year follow-up.

Related Experiment Videos

  • Comparison of outcomes based on dissection of N2 nodes, N1 nodes, or no nodes (N0).

    • Main Results:

    • Patients with N2 node dissection (n=695) had a median survival of 19.7 months and 5-year survival of 26.3%.
    • Patients with N1 node dissection (n=1,529) had a median survival of 24.8 months and 5-year survival of 30%.
    • Patients with no nodes removed (n=903) had a median survival of 29.5 months and 5-year survival of 35.6%.

    Conclusions:

    • Extragastric lymph node dissection (D2) of N2 nodes did not improve survival compared to gastrectomy without node dissection or with perigastric node dissection.
    • Subgroup analysis of patients with curative resection did not demonstrate a survival benefit from extragastric node dissection (D2).
    • Further investigation through ongoing clinical trials is warranted for more conclusive evidence.