| Nodal dissection for gastric cancer patient provides survival benefit when done by well-trained, experienced surgeons in high gastric cancer volume hospital
The
survival benefit and morbidity after nodal dissection for gastric cancer
remains controversial. We have conducted a prospective randomised trial to
compare D1 and D3 dissection at a single institution, focusing on advanced
gastric cancer. From
Oct 1993 to August 1999, 335 patients were registered. 221 patients were
eligible, 110 of whom were randomly assigned D1 surgery and 111 of whom
were randomly assigned D3 surgery, both with curative intent. Three
participating surgeons had done at least 25 independent D3 dissection
before the start of the trial, and every procedure was verified by
pathological analyses. Our short-term morbidity was higher in assigned D3
dissection (17.1%) compared with those assigned D1 (7.3%). There were no
deaths in either group during the same admission or after discharge within
30 days of the operation. D3 dissection was associated with more
complications, blood loss, operation time, and a longer hospital stay than
was D1 dissection. Median
follow-up for the 110 (50%) survivors was 94.5 months (range 62.9-135.1).
Overall 5 year survival was significantly higher in patients assigned D3
surgery than in those assigned D1 surgery (59.5%[95% CI 50.3-68.7%] vs.
53.6% [44.2-63.0]; difference between groups 5.9% [-7.3 to 19.1], log-rank
p=0.041). 215 patients who had R0 resection (ie. no microscopic evidence
of residual disease) had recurrence at 5 years of 50.6% [41.1-60.2] for D1
surgery and 40.3% [30.9-49.7] for D3 surgery (difference between groups
10.3% [-3.2 to 23.7], log-rank p=0.197). We
believe that a D3 resection for gastric cancer provides survival benefit
by well-trained, experienced surgeons in high gastric cancer volume
hospitals with minimal
morbidity. Bibliographical
reference: Wu
et al. “Randomized clinical study of morbidity after D1 and D3 surgery
for gastric cancer” Br J Surg 2004; 91:283-287. Chew-Wun
Wu Section of General Surgery, National Yang-Ming University and Taipei Veterans General Hospital, Taiwan
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