Tudor Stefan, Dumitrascu Traian, Manuc Mircea, Trandafir Bogdan, Ionescu Mihnea, Popescu Irinel, Herlea Vlad, Vasilescu Catalin
Chirurgia (Bucur). 2018 Nov-Dec;113(6):772-779. doi: 10.21614/chirurgia.113.6.772.
Surgery is the main component of the multimodality treatment of gastric cancer (GC). The present study aims to comparatively assess the early and long-term outcomes after D1 and D2 lymph node dissection. Furthermore, the impact of surgeon case-load on the long-term survival after D2 gastrectomies is also explored. A number of 773 patients with curative-intent surgery for GC adenocarcinoma (1997 - 2010: 325 patients with D1 lymphadenectomy, 448 patients with D2 lymphadenectomy) were included. No statistically significant differences of overall morbidity rates were observed between the D1 and D2 groups of patients (16.3%for D1 group vs. 18.8% for D2 group, p = 0.39). However, statistically significant higher rates of post operative pancreatic fistulae rates were observed in the D2 group of patients (3.2% for D1 group vs. 7.9% for D2 group, p 0.001). Interestingly, statistically significant higher rates of mortality were observed for the D1 group of patients (8.9% for D1 group vs. 2.9% for D2 group, p 0.001). The 5-year survival rate was statistically significant higher in the D2 group of patients (median overall survival time of 18 months for D1 group vs. 60 months for D2 group, p 0.001). A statistically significant correlation (p=0.005, r=0.571) was observed between the overall survival time and the number of D2 lymphadenectomies performed by each surgeon. D2 lymph node dissection is associated with statistically significant improved longterm survivals at the expense of higher postoperative pancreatic fistulae rates, compared to D1 surgery. However, no increased mortality rates were observed in the D2 group of patients. D2 radical gastrectomies should be performed in high-volume centers by high case-load surgeons.
手术是胃癌多模式治疗的主要组成部分。本研究旨在比较评估D1和D2淋巴结清扫术后的早期和长期结果。此外，还探讨了外科医生手术量对D2胃切除术后长期生存的影响。纳入了773例接受胃癌腺癌根治性手术的患者（1997 - 2010年：325例行D1淋巴结清扫术，448例行D2淋巴结清扫术）。D1组和D2组患者的总体发病率无统计学显著差异（D1组为16.3%，D2组为18.8%，p = 0.39）。然而，D2组患者术后胰瘘发生率在统计学上显著更高（D1组为3.2%，D2组为7.9%，p<0.001）。有趣的是，D1组患者的死亡率在统计学上显著更高（D1组为8.9%，D2组为2.9%，p<0.001）。D2组患者的5年生存率在统计学上显著更高（D1组的中位总生存时间为18个月，D2组为60个月，p<0.001）。观察到总生存时间与每位外科医生进行的D2淋巴结清扫数量之间存在统计学显著相关性（p = 0.005，r = 0.571）。与D1手术相比，D2淋巴结清扫与统计学上显著改善的长期生存率相关，但术后胰瘘发生率更高。然而，D2组患者未观察到死亡率增加。D2根治性胃切除术应由手术量高的外科医生在高容量中心进行。
