The influence of stage migration on the comparison of surgical outcomes between D2 gastrectomy and D3 gastrectomy (para-aortic lymph node dissection): a multi-institutional retrospective study

Kunisaki, Chikara; Takahashi, Masazumi; Fukushima, Tadao; Nagahori, Yutaka; Akiyama, Hirotoshi; Makino, Hirochika; Otsuka, Yuichi; Ono, Hidetaka A.; Kosaka, Takashi; Takagawa, Ryo; Shimada, Hiroshi

doi:10.1016/j.amjsurg.2007.07.031

« Previous Next »The American Journal of Surgery
Volume 196, Issue 3 , Pages 358-363, September 2008

The influence of stage migration on the comparison of surgical outcomes between D2 gastrectomy and D3 gastrectomy (para-aortic lymph node dissection): a multi-institutional retrospective study

Chikara Kunisaki, M.D., PhD.
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
- Corresponding author. Tel. +81-45-787-2650; fax: +81-45-782-9161
Masazumi Takahashi, M.D., Ph.D.
- Department of Surgery, Yokohama Municipal Hospital, 56 Okazawa-cho Hodogaya-ku, 240-0062, Japan
Tadao Fukushima, M.D., Ph.D.
- Department of Surgery, Yokosuka Kyosai Hospital, 1-16 Yonegawahadori Yokosuka, 238-0011 Japan
Yutaka Nagahori, M.D., PhD.
- Department of Surgery, Yokosuka Kyosai Hospital, 1-16 Yonegawahadori Yokosuka, 238-0011 Japan
Hirotoshi Akiyama, M.D., Ph.D.
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
Hirochika Makino, M.D.
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
Yuichi Otsuka, M.D.
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
Hidetaka A. Ono, M.D., Ph.D.
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
Takashi Kosaka, M.D.
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
Ryo Takagawa, M.D.
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
Hiroshi Shimada, M.D., PhD
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

Received 25 March 2007; received in revised form 12 July 2007 published online 09 May 2008.

Abstract

Background

The aim of this study was to determine the influence of stage migration on the outcomes of D2 gastrectomy compared with D3 gastrectomy in advanced gastric cancer.

Methods

A series of 580 advanced gastric cancer patients (430 D2 gastrectomy and 150 D3 gastrectomy) were registered. The incidence of stage migration and the surgical results of D2 and D3 gastrectomy were compared.

Results

The incidence of N-stage migration was 22.7% and that of pathological stage was 20.7%. Stage-specific survival times of simulated D2 gastrectomy and real D2 gastrectomy were equal. In patients with pN2 tumors measuring 50 to 100 mm in diameter, there was a significant difference in survival between D2 and D3 gastrectomy. However, no difference was observed between D2 and simulated D2 gastrectomy.

Conclusions

Because there was a high incidence of stage migration in patients after D3 gastrectomy, it may be more feasible to validate comparisons between different levels of lymph node dissection in a randomized controlled trial.

Keywords: Gastrectomy, Gastric cancer, Para-aortic lymph node dissection, Stage migration