Surgical treatment of gastric cancer the role of extended lymphadenectomy

Abstract EN

Purpose : For patients with gastric cancer, surgical resection with a lymph node dissection is considered a potentially curative treatment.

The prognostic benefit of extended lymph node dissection (D2) is still controversial.

Accordingly, our objective in this study is to investigate the feasibility of this type of dissection and the value of intraoperative contrast medium in the demonstration of the lymphatic system and lymph node’s draining area and to evaluate the different prognostic factors using univariate and multi-variety analysis and to compare the survival of patients subjected to D2 dissection to a historical group of patients with gastric cancer treated at the NCI Cairo University.

Patients and Methods: Thirty-three patients with gastric carcinoma underwent radical gastrostomy with systematic lymph node dissection (D2 dissection) as described by the Japanese Research Society for Gastric Cancer (JRSGC, 1998).

In NCI.

Cairo University and South Egypt Cancer Institute (S.E.C.A) Assiut University and Aswan Cancer Center between October 1999 and September 2001 using black contrast medium (CH-40) India ink for lymphatic mapping intra operatively.

The prognostic factors using univariate and multivariate analysis and the survival were compared to the results of a group of patients with gastric cancer treated in NCI before 1998.

Results: The 2 year overall and disease free survival rates were 43.6% and 42.5% respectively.

Serosa invasion, curability of resection, combined resection, depth of invasion and number of resected lymph nodes were the most significant prognostic factors.

Type of operation, lymph nodes metastasis, ratio of involved to resected nodes, level of lymph node metastasis (N stage by the Japanese Staging System), tumor location, histology and UICC stage also had prognostic significance on univariate analysis.

The number of resected lymph nodes was a highly significant prognostic factor suggesting the importance of an extended lymph node dissection.

The operative morbidity was 15 % and hospital mortality rate was 3 %.

These results were much better than the historical group (97 patients) treated in NCI before 1998 without the extended lymph node dissection where the mortality rate was 18.5 % and morbidity was 23.7 % while the 2 year overall and disease free survival rates were 30.1 % and 28.8 % respectively.

On multivariate analysis, serosa invasion, tumor location, level of lymph node metastasis (N) stage by the Japanese Staging System and tumor histology were independent significant prognostic factors.

Intraoperative lymphography using fine activated carbon particle solution proved to be effective in facilitating an extended lymphadenectomy in node -ve patients.

Conclusion : in Egypt gastric cancer usually presents late in advanced stage with a poor outcome.

Early diagnosis, appropriate staging and adequate surgical resection with extended lymphadenectomy (D2) are the most important requirements for a successful outcome.

Extended lymph node dissection is feasible and not associated with an increased morbidity or mortality and can improve results of surgery in cases with curable gastric cancer.

Intraoperative lymphography facilitates such extended lymph adenectomy.