Document Detail

Operative morbidity and mortality after D2 and D4 extended dissection for advanced gastric cancer: a prospective randomized trial conducted by Asian surgeons.
MedLine Citation:
PMID:  16795979     Owner:  NLM     Status:  MEDLINE    
BACKGROUND/AIMS: A randomized study was performed to evaluate morbidity and mortality after D2 (level 1 and 2 lymphadenectomy) and D4 (D2 plus lymphadenectomy of para-aortic lymph nodes) dissection for advanced gastric cancer. METHODOLOGY: Two hundred and fifty-six patients with advanced gastric adenocarcinoma were enrolled (128 to each group). Patients were randomly allocated into D2 (N = 128) or D4 (N = 128) group. The first and second tiers of lymph nodes are removed in D2 dissection. In D4 gastrectomy, the paraaortic lymph nodes were additionally removed. RESULTS: There was no indication of significant distribution bias with regard to age, sex, T-grade, and N-grade between the two groups. Operation time of D4 gastrectomy (369 +/- 120 min) was significantly longer than that of D2 gastrectomy (273 +/- 1103 min), and blood loss of the D4 group (872 +/- 683 mL) was significantly greater than that of the D2 group 571 +/- 527 mL (P < 0.001). Five (4%) and two (2%) medical complications developed in the D2 and D4 groups, respectively. Surgical complications developed in 28 (22%) and 48 patients (38%) after D2 and D4 gastrectomy. The most common complications were anastomotic leakage, pancreatic fistula, and abdominal abscess. Pancreatic fistula developed in 6 (19%) of 32 patients after D4 plus pancreatosplenectomy, but the incidence of pancreatic fistula after D2 gastrectomy plus pancreatosplenectomy was low (6%, 1/16). Two patients died within 30 days of operation (0.8%, 2/256), and each patient belonged to the D2 and D4 group. CONCLUSIONS: Although there is a significantly higher surgical complication rate in D4 dissection, D4 dissection can be done safely as D2 dissection when performed by well-trained surgeons.
Y Yonemura; C C Wu; N Fukushima; I Honda; E Bandou; T Kawamura; S Kamata; H Yamamoto; B S Kim; N Matsuki; T Sawa; S H Noh;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  Hepato-gastroenterology     Volume:  53     ISSN:  0172-6390     ISO Abbreviation:  Hepatogastroenterology     Publication Date:    2006 May-Jun
Date Detail:
Created Date:  2006-06-26     Completed Date:  2007-10-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8007849     Medline TA:  Hepatogastroenterology     Country:  Greece    
Other Details:
Languages:  eng     Pagination:  389-94     Citation Subset:  IM    
Gastric Surgery Division, Peritoneal Dissemination Program, Shizuoka Cancer Center, 1007 Shimo-nagakubo, Nagaizumi-machi, Suntou-gun, Shizuoka 411-8777, Japan.
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MeSH Terms
Abdominal Abscess / epidemiology,  etiology*,  mortality
Adenocarcinoma / mortality,  pathology,  surgery*
Gastrectomy / adverse effects*
Lymph Node Excision / adverse effects*,  methods
Lymphatic Metastasis
Middle Aged
Pancreatic Fistula / epidemiology,  etiology*,  mortality
Postoperative Complications*
Prospective Studies
Stomach Neoplasms / mortality,  pathology,  surgery*
Survival Analysis
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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