Aggressive D2 Lymphadenectomy is Required for Accurate Pathologic Staging of Gastric Adenocarcinoma

Smith, Brian R.; Stabile, Bruce E.
October 2006
American Surgeon;Oct2006, Vol. 72 Issue 10, p849
Academic Journal
The therapeutic efficacy of aggressive regional D2 lymphadenectomy as an adjunct to gastrectomy for adenocarcinoma of the stomach remains controversial. It is hypothesized that D2 lymphadenectomy compared with limited D1 lymphadenectomy increases nodal yield without adding to operative morbidity or mortality, and is necessary to allow accurate pathologic staging according to current American Joint Committee on Cancer (AJCC) criteria. A 10-year retrospective review of a consecutive series of 105 gastrectomies for adenocarcinoma at an urban public teaching hospital was performed. Of 69 intended curative gastrectomies, 55 (80%) included D2 lymphadenectomies, whereas of 36 palliative gastrectomies, only 9 (25%) included D2 lymphadenectomies (P = 0.0041). Only D2 and not D1 lymphadenectomy achieved the AJCC minimum guideline of the 15 lymph nodes required for accurate pathologic staging (mean 25.2 vs 12.4 nodes, respectively; P = 0.0001). For D2 cases, 86 per cent had greater than 15 nodes excised compared with only 20 per cent for D1 cases (P = 0.0002). The morbidity and mortality rates for D2 and D1 operations were 22 per cent and 2 per cent, and 41 per cent and 2 per cent, respectively. We conclude that there was no increased morbidity or mortality associated with D2 lymphadenectomy; that reliable harvesting of an adequate number of lymph nodes for accurate AJCC pathologic tumor staging requires D2 lymphadenectomy; and that D2 lymphadenectomy should be performed as part of virtually all gastrectomies for invasive adenocarcinoma having curative intent.


Related Articles

  • Time to Death and Pattern of Death in Recurrence following Curative Resection of Gastric Carcinoma: Analysis Based on Depth of Invasion. Otsuji, Eigo; Kuriu, Yoshiaki; Ichikawa, Daisuke; Okamoto, Kazuma; Ochiai, Toshiya; Hagiwara, Akeo; Yamagishi, Hisakazu // World Journal of Surgery;Sep2004, Vol. 28 Issue 9, p866 

    It is difficult to predict recurrence in patients who undergo curative gastrectomy for gastric carcinoma. If the timing and site of recurrence can be predicted, it becomes easier to detect recurrent disease. Records of 290 patients who died of tumor recurrence after curative gastrectomy for...

  • Gastric Acid-Dependent Diseases: A Twentieth-Century Revolution. Sachs, George; Shin, Jai; Munson, Keith; Scott, David // Digestive Diseases & Sciences;Jul2014, Vol. 59 Issue 7, p1358 

    No abstract available.

  • Clinicopathologic and Prognostic Characterization of Poorly Differentiated Medullary-type Gastric Adenocarcinoma. Otsuji, Eigo; Kuriu, Yoshiaki; Ichikawa, Daisuke; Ochiai, Toshiya; Okamoto, Kazuma; Hagiwara, Akeo; Yamagishi, Hisakazu // World Journal of Surgery;Sep2004, Vol. 28 Issue 9, p862 

    Poorly differentiated medullary-type gastric adenocarcinoma has been reported to differ biologically from poorly differentiated scirrhous adenocarcinoma, and we have characterized the differences in greater detail. Clinicopathologic comparisons were made between the former and latter tumor types...

  • Cerebral venous sinus thrombosis: An unusual initial presentation of mucinous adenocarcinoma of stomach. Jena, Subhransu Sekhar; Nayak, Soumyadarshan; Behera, Ishwar Chandra; Mohapatra, Debahuti; Tripathy, Subrat Kumar // Neurology India;Nov/Dec2014, Vol. 62 Issue 6, p695 

    The article describes the case of a 56-year-old woman who developed mucinous infiltrating adenocarcinoma of stomach. The patient presented with headache and intermittent projectile vomiting for 10 days. She underwent treatment with low molecular weight heparin, antiepileptics and anti edema...

  • Indications for EMR/ESD in cases of early gastric cancer: relationship between histological type, depth of wall invasion, and lymph node metastasis. Ishikawa, Shinji; Togashi, Akihiko; Inoue, Mituhiro; Honda, Shinobu; Nozawa, Fumiaki; Toyama, Eiichirou; Miyanari, Nobutomo; Tabira, Youichi; Baba, Hideo // Gastric Cancer;Mar2007, Vol. 10 Issue 1, p35 

    Limited surgery by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for gastric cancer is frequently performed in many institutions. These techniques do preserve gastric function and maintain a high quality of life but may compromise survival. The treatment strategy...

  • Minimally Invasive Surgery for Gastric Cancer Treatment: Current Status and Future Perspectives. Taeil Son; In Gyu Kwon; Woo Jin Hyung // Gut & Liver;May2014, Vol. 8 Issue 3, p229 

    Minimally invasive surgery, which has been extensively used to treat gastric adenocarcinoma, is now regarded as one of the standard treatments for early gastric cancer, and its suitability for advanced gastric cancer is being investigated. The use of cutting-edge techniques for minimally...

  • Ectopic Pancreas in the Stomach Presenting as an Inflammatory Abdominal Mass. Kaneda, Makoto; Yano, Takashi; Yamamoto, Toshio; Suzuki, Takashi; Fujimori, Kenji; Itoh, Hiroyuki; Mizumoto, Ryuji // American Journal of Gastroenterology;Jun1989, Vol. 84 Issue 6, p663 

    A case of 29-yr-old woman with an ectopic pancreas in the stomach, presenting as an inflammatory mass, is presented. Physical examination revealed a tender mass in the upper abdomen. Laboratory data showed leukocytosis and an increase of ESR and CRP. A computed tomographic (CT) scan demonstrated...

  • A technical surgery for refractory gastroparesis in a patient with a mitochondrial disorder. Tatekawa, Yukihiro; Komuro, Hiroaki // Pediatric Surgery International;Jun2010, Vol. 26 Issue 6, p655 

    Gastroparesis is a symptomatic chronic disorder of the stomach characterized by delayed gastric emptying in the absence of mechanical obstruction. Gastroparesis has been associated with various diseases and may occur as part of a mitochondrial disorder. In a patient with pyruvate dehydrogenase...

  • Association of Antioxidative Enzymes Polymorphisms with Efficacy of Platin and Fluorouracil-Based Adjuvant Therapy in Gastric Cancer. Honghong Zhang; Weiyong Zhao; Dongying Gu; Mulong Du; Weida Gong; Yongfei Tan; Meilin Wang; Juan Wen; Yongning Zhai; Zhi Xu // Cellular Physiology & Biochemistry (Karger AG);Aug2018, Vol. 48 Issue 6, p2247 

    Background/Aims: Imbalance of oxidative/antioxidative enzymes in cells is associated with carcinogenesis and cancer cell chemoresistance. The aim of this study was to examine the clinical significance of potentially functional single nucleotides polymorphisms (SNPs) in antioxidative enzymes,...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics