Oncologic feasibility of D1+ gastrectomy for patients with cT1N1, cT2N0-1, or cT3N0 gastric cancer |
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| Affiliation: | 1. Department of Surgery, Saitama Medical Center, Saitama, 330-0074, Japan;2. Department of Pathology, Saitama Medical Center, Saitama, 330-0074, Japan;1. Academic Unit of Colorectal Surgery, University of Glasgow, Level 2, New Lister Building, Glasgow Royal Infirmary, 10 – 16 Alexandra Parade, Glasgow G31 2ER, Scotland, UK;2. Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK;3. Undergraduate School of Medicine, Wolfson Medical School Building, University Avenue, Glasgow, G12 8QQ, Scotland, UK;4. Department of Gynaecological Oncology, Glasgow Royal Infirmary, PRMH Building, 16 Alexandra Parade, Glasgow, G31 2ER, Scotland, UK;1. Department of Surgery, University of Modena and Reggio Emilia – Policlinico of Modena, Modena Italy Via Del Pozzo, 71 41100, Modena, Italy;2. Department of General Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be’er Ya’akov, Israel, Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;3. Dept. of Surgery, University of Modena and Reggio Emilia –Via Del Pozzo, 71 41124 Modena, Italy;1. St James’s Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK;2. Royal Marsden NHS Foundation Trust, London, UK;3. Cobalt Medical Charity, Cheltenham, UK;4. Gloucestershire Hospitals NHS Foundation Trust, UK;5. Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, CB20QQ, UK;6. CEITEC, Masaryk University, Brno, Czech Republic;7. Barts Health NHS Trust, London, UK;8. Royal Free Hospital, London, UK;9. Bristol Plastic Surgery, 58 Queen Square, Bristol, BS1 4LF, UK;1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA;2. Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA;3. Department of Obstetrics and Gynecology, University of Freiburg, Freiburg, Germany;4. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA;5. Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan;6. Department Obstetrics and Gynecology, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan;1. Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea;2. Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea |
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| Abstract: | IntroductionD2 gastrectomy has shown a survival benefit in patients with highly advanced gastric cancer; however, it remains unclear whether D2 gastrectomy is required for patients with early-stage advanced gastric cancer or early gastric cancer with limited lymph node metastasis. This analysis aimed to clarify the oncologic feasibility of D1+ gastrectomy in patients with cT1N1, cT2N0-1, or cT3N0 gastric cancer.MethodsThis retrospective cohort analysis included 466 patients with cT1N1, cT2N0-1, or cT3N0 gastric cancer who received curative gastrectomy with either D2 or D1+ dissection. Surgical outcomes were compared between the D2 group (n = 406) and the D1+ group (n = 60).ResultsThe number of patients with higher age and higher comorbidity index was greater in the D1+ group than in the D2 group. Postoperative complications were significantly lower in the D1+ group than in the D2 group (10.0% vs. 26.8%, p = 0.004). No statistically significant difference in 5-year overall survival (p = 0.146) and disease-specific survival (p = 0.807) between the groups was noted. The incidence of local recurrences (p = 0.500) and that of lymph node recurrences (p = 1.000) were also similar between the groups. Multivariable analysis for overall survival identified age, clinical node-positive status, high Charlson score (≥3), advanced pathological stage (≥III), and postoperative complication (grade ≥ II) as independent prognostic factors. The propensity score-matched analysis showed very similar survival outcomes between the groups.ConclusionD1+ gastrectomy may be oncologically feasible for patients with cT1N1, cT2N0-1, or cT3N0 stage gastric cancer. |
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| Keywords: | Gastric carcinoma Lymphadenectomy Survival Recurrence Comorbidity |
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