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Randomized clinical trial of D2 and extended paraaortic lymphadenectomy in patients with gastric cancer.

Authors
 Yutaka Yonemura  ;  Cheng-Chung Wu  ;  Norimasa Fukushima  ;  Ichirou Honda  ;  Etsurou Bandou  ;  Taiichi Kawamura  ;  Tohru Kamata  ;  Byung-Sik Kim  ;  Nobuo Matsuki  ;  Toshiharu Sawa  ;  Sung-Hoon Noh 
Citation
 INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY, Vol.13(2) : 132-137, 2008 
Journal Title
INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY
ISSN
 1341-9625 
Issue Date
2008
MeSH
Adenocarcinoma/mortality ; Adenocarcinoma/pathology ; Adenocarcinoma/surgery* ; Aged ; Aorta ; Female ; Gastrectomy/methods* ; Humans ; Lymph Node Excision/methods* ; Male ; Middle Aged ; Stomach Neoplasms/mortality ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery* ; Survival Analysis
Keywords
Gastric cancer ; Gastrectomy ; Lymphadenectomy ; Paraaortic lymph nodes ; D2 dissection ; D4 dissection
Abstract
BACKGROUND: The survival of patients with advanced gastric cancer after D2 dissection is still poor. Asian surgeons have proposed a more radical lymph node dissection, designated as D4 dissection, where paraaortic lymph nodes are removed in combination with D2 dissection. To evaluate the survival benefit of D4 dissection, a multi-institutional randomized trial of D2 vs D4 gastrectomy was conducted. METHODS: Patients enrolled in the study had potentially curable gastric adenocarcinoma at an advanced stage. Patients were randomized to undergo either D2 or D4 gastrectomy. RESULTS: Two hundred and ninety-three patients were registered and 269 patients were eligible; 135 patients were allocated to the D2 group and 134 to the D4 group. Five-year survival was 52.6% after D2 surgery and 55.0% after D4 gastrectomy. There was no significant difference in survival between the D2 and D4 groups (chi(2) = 0.064; P = 0.801). Hospital deaths occurred in 1 patients (0.7%) in the D2 group and 5 in the D4 group D4 gastrectomy is a more risky surgery than D2 dissection. Seven patients (5.2%) in the D2 and 15 (11.2%) in the D4 group died of causes other than gastric cancer recurrence. Sixty-three patients (46.7%) in the D2 group and 52 (38.8%) in the D4 group had disease recurrence. CONCLUSION: Prophylactic D4 dissection is not recommended for patients with potentially curable advanced gastric cancer
Full Text
http://link.springer.com/article/10.1007%2Fs10147-007-0727-1
DOI
10.1007/s10147-007-0727-1
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Noh, Sung Hoon(노성훈) ORCID logo https://orcid.org/0000-0003-4386-6886
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/107304
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