Optimal Extent of Lymphadenectomy for Gastric Adenocarcinoma: A 7-Institution Study of the US Gastric Cancer Collaborative

• Type of Material: Article
• Authors: Reese W. Randle, Wake Forest School of Medicine; Douglas S. Swords, Wake Forest School of Medicine; Edward A. Levine, Wake Forest School of Medicine; Nora F. Fino, Wake Forest School of Medicine; Malcolm H. Squires, Emory University; George Poultsides, Stanford University; Ryan C. Fields, Washington University; Mark Bloomston, Ohio State University; Sharon M. Weber, University of Wisconsin; Timothy M. Pawlik, Johns Hopkins University; Linda X. Jin, Washington University; Gaya Spolverato, Johns Hopkins University; Carl Schmidt, Ohio State University; David Worhunsky, Stanford University; Clifford S. Cho, University of Wisconsin; Shishir Maithel, Emory University; Konstantinos I. Votanopoulos, Wake Forest School of Medicine
• Language: English
• Date: 2016-03-21
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 1999 - 2017 John Wiley & Sons, Inc. All Rights Reserved. This is the peer reviewed version of the following article, which has been published in final form. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
• Final Published Version (URL): http://dx.doi.org/10.1002/jso.24227
• Title of Journal or Parent Work: Journal of Surgical Oncology
• ISSN: 0022-4790
• Volume: 113
• Issue: 7
• Start Page: 750
• End Page: 755
• Grant/Funding Information: Grant sponsor: Wake Forest University Biostatistics Shared Resource NCI CCSG; Grant number: P30CA012197.
• Keywords: Surgery; SURVIVAL; D2 lymphadenectomy; gastrectomy; SURGICAL TRIAL; Science & Technology; D-2 RESECTIONS; MORBIDITY; Life Sciences & Biomedicine; gastric adenocarcinoma; STATISTICS; D2 GASTRECTOMY; Oncology; MORTALITY
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background and Objectives: The optimal extent of lymphadenectomy in the treatment of gastric adenocarcinoma is debated. We compared gastrectomy outcomes following limited (D1) or extended (D2) lymphadenectomy. Method: Using the multi-institutional US Gastric Cancer Collaborative database, we reviewed the morbidity, mortality, recurrence, and overall survival (OS) of patients receiving D1 or D2 lymphadenectomies. Results: Between 2000 and 2012, 266 and 461 patients received a D1 and D2 lymphadenectomy, respectively. ASA class, mean number of comorbidities, grade, and stage were similar between groups. While major morbidity was similar (P = 0.85), mortality was worse for those receiving a D1 lymphadenectomy (4.9% vs. 1.3%, P = 0.004). D2 lymphadenectomy was associated with improved median OS in stage I (4.7 years for D1 vs. not reached for D2, P = 0.003), stage II (3.6 years for D1 vs. 6.3 for D2, P = 0.42), and stage III patients (1.3 years for D1 vs. 2.1 for D2, P = 0.01). After adjusting for predictors of OS, D2 lymphadenectomy remained a significant predictor of improved survival (HR 1.5, 95%CI 1.1–2.0, P = 0.008). Conclusions: D2 lymphadenectomy can be performed without increased risk of morbidity and mortality. Additionally, D2 lymphadenectomy is associated with improved survival especially in early stages, and should be considered for gastric adenocarcinoma patients. J. Surg. Oncol.