Skip to main content
SpringerLink
Log in

Comparison of Surgical Results of D2 Versus D3 Gastrectomy (Para-Aortic Lymph Node Dissection) for Advanced Gastric Carcinoma: A Multi-Institutional Study

  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Curative gastrectomy is a promising approach for the treatment of gastric cancer; however, the optimal extent of lymph node dissection for advanced cancer remains controversial. The aim of this multi-institutional study was to evaluate the feasibility of D3 gastrectomy (para-aortic lymph node dissection) for advanced gastric cancer. The surgical results of D2 and D3 gastrectomy (para-aortic lymph node dissection) were retrospectively compared.

Methods

A series of 580 advanced gastric cancer patients were registered between 1992 and 2000. Of these, 430 underwent D2 gastrectomy and 150 underwent D3 gastrectomy. Survival time, prognostic factors, postoperative morbidity/mortality, and pattern of recurrence were compared.

Results

There was no significant difference in survival time between D2 and D3 patients. However, the survival times of D3 patients with tumor diameters measuring 50 to 100 mm or with pN1 disease were significantly longer than those of the corresponding D2 patients. Analysis of the survival of patients with tumor diameters measuring 50 to 100 mm revealed that D3 gastrectomy conferred a survival advantage only to patients with pN2 disease. The incidence of lymphatic recurrence was lower in D3 patients with 50- to 100-mm tumors than in the corresponding D2 patients.

Conclusions

D3 gastrectomy might be beneficial in patients with advanced pN2 gastric cancer within the group with tumors measuring 50 to 100 mm. A randomized controlled trial of patients with 50- to 100-mm tumors should be performed to test the validity of this preliminary result.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Nakajima T. Gastric cancer treatment guidelines in Japan. Gastric Cancer 2002; 5:1–5

    Article  PubMed  Google Scholar 

  2. Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomized controlled surgical trial. The Surgical Cooperative Group. Lancet 1996; 347:995–9

    Article  CAS  PubMed  Google Scholar 

  3. Bonenkamp JJ, Songun I, Hermans J, et al. Randomized comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 1995; 345:745–8

    Article  CAS  PubMed  Google Scholar 

  4. Sasako M. Risk factors for surgical treatment in the Dutch Gastric Cancer Trial. Br J Surg 1997; 84:1567–71

    Article  CAS  PubMed  Google Scholar 

  5. Fujii M, Sasaki J, Nakajima T. State of the art in the treatment of gastric cancer: from the 71st Japanese Gastric Cancer Congress. Gastric Cancer 1999; 2:151–7

    Article  PubMed  Google Scholar 

  6. Isozaki H, Okajima K, Fujii K, et al. Effectiveness of paraaortic lymph node dissection for advanced gastric cancer. Hepatogastroenterology 1999; 46:549–54

    CAS  PubMed  Google Scholar 

  7. Baba M, Hokita S, Natsugoe S, et al. Paraaortic lymphadenectomy in patients with advanced gastric carcinoma of the upper-third of the stomach. Hepatogastroenterology 2000; 47:893–6

    CAS  PubMed  Google Scholar 

  8. Kunisaki C, Shimada H, Yamaoka H, et al. Indications for para-aortic lymph node dissection in gastric cancer patients with para-aortic lymph node involvement. Hepatogastroenterology 2000; 47:586–9

    CAS  PubMed  Google Scholar 

  9. Kunisaki C, Shimada H, Takahashi M, et al. Implication of extended lymph node dissection stratified for advanced gastric cancer. Anticancer Res 2003; 23:4181–6

    PubMed  Google Scholar 

  10. Sasaki J, Nashimot A, Tutui H, et al. Indication of paraaortic lymph node dissection for gastric cancer (in Japanese). Jpn J Gastroenterol Surg 1989; 22:1749–54

    Google Scholar 

  11. Kitamura M, Arai K, Miyashita K, et al. Clinicopathological studies on para-aortic lymph node metastasis in gastric cancer (in Japanese). Jpn J Gastroenterol Surg 1991; 24:1905–10

    Google Scholar 

  12. Japanese Gastric Cancer Association. Japanese classification of gastric cancer. 2nd English edition. Gastric Cancer 1998; 1:8–24

    Article  Google Scholar 

  13. Sobin LH, Wittenkind CH, eds. TNM Classification of Malignant Tumors. International Union Against Cancer. 5th ed. New York: John Wiley & Sons, 1997

    Google Scholar 

  14. Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy. Japan Clinical Oncology Group Study 9501. J Clin Oncol 2004; 22:2767–73

    Article  PubMed  Google Scholar 

  15. Kunisaki C, Shimada H, Yamaoka H, et al. Significance of para-aortic lymph node dissection in advanced gastric cancer. Hepatogastroenterology 1999; 46:2635–42

    CAS  PubMed  Google Scholar 

  16. Nomura M, Kunisaki C, Akiyama H, et al. Surgical outcome of para-aortic lymph node dissection preserving neural tissue based on anatomical evaluations. J Gastrointest Surg 2005; 9:781–8

    Article  PubMed  Google Scholar 

  17. Nakajima T. Gastric cancer treatment guidelines in Japan. Gastric Cancer 2002; 5:1–5

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Chikara Kunisaki MD, PhD, Hirotoshi Akiyama MD, PhD, Masato Nomura MD, PhD, Goro Matsuda MD, PhD, Yuichi Otsuka MD, PhD, Hidetaka Ono MD, PhD & Hiroshi Shimada MD, PhD

  2. Department of Surgery, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, 238-0011, Japan

    Yutaka Nagahori MD, PhD & Hideo Hosoi MD, PhD

  3. Department of Surgery, Yokohama Municipal Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-0062, Japan

    Masazumi Takahashi MD, PhD & Fumihiko Kito MD, PhD

Authors
  1. Chikara Kunisaki MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hirotoshi Akiyama MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masato Nomura MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Goro Matsuda MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuichi Otsuka MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hidetaka Ono MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yutaka Nagahori MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hideo Hosoi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Masazumi Takahashi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Fumihiko Kito MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hiroshi Shimada MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chikara Kunisaki MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kunisaki, C., Akiyama, H., Nomura, M. et al. Comparison of Surgical Results of D2 Versus D3 Gastrectomy (Para-Aortic Lymph Node Dissection) for Advanced Gastric Carcinoma: A Multi-Institutional Study. Ann Surg Oncol 13, 659–667 (2006). https://doi.org/10.1245/ASO.2006.07.015

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/ASO.2006.07.015

Keywords

Search

Navigation