Uslu Adam, Zengel Baha, İlhan Enver, Aykas Ahmet, Şimşek Cenk, Üreyen Orhan, Duran Ali, Okut Gökalp
Department of General Surgery, University of Health Sciences, Izmir Bozyaka Research and Training Hospital, İzmir, Turkey.
Turk J Surg. 2018 Jul 1;34(2):125-130. doi: 10.5152/turkjsurg.2018.3846. eCollection 2018.
D2 lymphadenectomy (D2-LND) with curative resection (R0) is the cornerstone of gastric cancer treatment. In this study, we compared survival outcomes of D2-LDN with D1-LDN in patients who had undergone curative resection for Stages II and III primary gastric adenocarcinoma.
Between April 1996 and March 2014, 153 consecutive patients with adenocarcinoma of the stomach underwent total gastrectomy with D1-LND or D2-LND. Among those, 118 patients (38 D1 vs. 80 D2) with a complete history and having been followed for at least 1 year after surgery were enrolled. Both groups were compared in terms of demographic and clinico-pathologic characteristics.
The mean follow-up was 42.6±52.5 months (mo.). The demographic characteristics of the groups were similar. The Tumor, Node and Metastases (TNM) stage distribution was 25% for Stage II and 75% for Stage III for both groups. Eighteen patients (47.4%) in the D1 and 47 patients (58.8%) in the D2 group were free from locoregional recurrence. The median disease-free survival was 22.0±4.1 mo. for the D1 and 28.0±4.3 mo. for the D2 group (p=0.36). Eight patients (21%) in the D1 and 39 patients (49%) in the D2 group were alive at the last follow-up. The median overall survival (OS) was 22.0±3.7 mo. for the D1 and 31.0±5.4 mo. for the D2 group (p=0.13). The 5-year disease-free survival and OS by the Kaplan-Meier estimates were 41% vs. 51% and 30% vs. 42% in the D1 and D2 groups, respectively. The median 5-year OS for patients with Stages IIIB and IIIC tumors was 14.0±2.2 mo. for the D1 and 20.0±5.0 mo. for the D2 group, respectively (p: 0.048).
When compared to D1-LND, D2-LND with R0 resection have yielded a trend toward a better outcome in patients with primary gastric adenocarcinoma.
根治性切除（R0）的D2淋巴结清扫术（D2-LND）是胃癌治疗的基石。在本研究中，我们比较了接受II期和III期原发性胃腺癌根治性切除的患者中D2-LND与D1-LND的生存结果。
1996年4月至2014年3月期间，153例连续性胃腺癌患者接受了D1-LND或D2-LND的全胃切除术。其中，118例有完整病史且术后至少随访1年的患者（38例D1组 vs. 80例D2组）被纳入研究。比较两组患者的人口统计学和临床病理特征。
平均随访时间为42.6±52.5个月（月）。两组患者的人口统计学特征相似。两组患者的肿瘤、淋巴结和转移（TNM）分期分布均为II期占25%，III期占75%。D1组18例患者（47.4%）和D2组47例患者（58.8%）无局部区域复发。D1组的无病生存期中位数为22.0±4.1个月，D2组为28.0±4.3个月（p = 0.36）。D1组8例患者（21%）和D2组39例患者（49%）在最后一次随访时仍存活。D1组的总生存期（OS）中位数为22.0±3.7个月，D2组为31.0±5.4个月（p = 0.13）。根据Kaplan-Meier估计，D1组和D2组的5年无病生存率分别为41%和51%，5年总生存率分别为30%和42%。IIIB期和IIIC期肿瘤患者的5年总生存期中位数，D1组为14.0±2.2个月，D2组为20.0±5.0个月（p：0.048）。
与D1-LND相比，R0切除的D2-LND在原发性胃腺癌患者中显示出预后更好的趋势。
