VOLUME 30 - NUMBER 51 - 2009

Ruolo della linfoadenectomia nel trattamento del cancro gastrico: analisi retrospettiva monocentrica su 406 pazienti

  • Vestri A., Canonico G., Scaringi S., Liscia G., Tonelli F.
  • Articolo Originale, 091-094
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  • Background: Several studies in the literature have investigated the surgical technique for gastric cancer treatment. Particularly the role of an extended lymphadenectomy is still controversial. Our study compared morbidity and mortality among patients that underwent lymphadenectomy D2 and D2 extended (D2+).

    Patients and Methods: 406 patients underwent surgery for gastric cancer. A total gastrectomy or a gastric resection with lymphadenectomy D2 or D2+ (extended to stations 12a, 12b, 12p) were performed.

    Results: 250 (62.8%) patients had advanced cancer at the moment of diagnosis (stages I-19.4%, II-17.8%, III-26.8%, IV-36%). 342 patients underwent curative surgery and among those D0/D1, D2, D2+ lymphadenectomies were respectively 3,6%, 37,9% and 58,5%. In D2 and D2+ lymphadenectomy the median survival was 54.2 (OS 47%) and 39.4 months (OS 44%) respectively. The 5-years overall survival by stages after D2 or D2+ was 66.7% and 77.8% in Stage I, 59.6% and 55.6% in S-II, 26.1% and 32.8% in S-III, 13.8% and 29.4% in S-IV (p=0.242). Morbidity and mortality were 16,6% and 7% in D2 group and 10.9% and 7% in D2+ group.

    Conclusions: Our experience suggests that a D2 lymphadenectomy can be performed with a satisfactory outcome in term of survival and mortality. D2+ lymphadenectomy does not seem to increase mortality and morbidity; however there are no significant differences in term of survival between the two techniques (p = 0,355).

  • KEY WORDS: gastric cancer, lymphadenectomy.