| Operative morbidity and mortality after D2 and D4 extended dissection for advanced gastric cancer: a prospective randomized trial conducted by Asian surgeons. | |
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MedLine Citation:
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PMID: 16795979 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial |
Journal Detail:
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Title: Hepato-gastroenterology Volume: 53 ISSN: 0172-6390 ISO Abbreviation: Hepatogastroenterology Publication Date: 2006 May-Jun |
Date Detail:
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Created Date: 2006-06-26 Completed Date: 2007-10-25 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8007849 Medline TA: Hepatogastroenterology Country: Greece |
Other Details:
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Languages: eng Pagination: 389-94 Citation Subset: IM |
Affiliation:
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Gastric Surgery Division, Peritoneal Dissemination Program, Shizuoka Cancer Center, 1007 Shimo-nagakubo, Nagaizumi-machi, Suntou-gun, Shizuoka 411-8777, Japan. y.yonemura@scchr.jp |
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| MeSH Terms | |
Descriptor/Qualifier:
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Abdominal Abscess
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epidemiology,
etiology*,
mortality Adenocarcinoma / mortality, pathology, surgery* Asia Female Gastrectomy / adverse effects* Humans Incidence Lymph Node Excision / adverse effects*, methods Lymphatic Metastasis Male Middle Aged Morbidity 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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