Division of Gastroenterologic Surgery, Chonnam National University Hwasun Hospital, Jeollanam-do, South Korea.
Division of Gastroenterologic Surgery, Chonnam National University Hwasun Hospital, Jeollanam-do, South Korea; Department of Surgery, Chonnam National University Medical School, Gwangju, South Korea.
Eur J Surg Oncol. 2020 Jul;46(7):1239-1246. doi: 10.1016/j.ejso.2020.04.013. Epub 2020 Apr 14.
D2 lymph node dissection (LND) is a widely performed as a standard procedure for advanced gastric cancer (AGC). However, there is little evidence supporting D2 over D1+ LND for gastric cancer treatment. This study compared the long-term outcomes of D2 and D1+ LND for AGC.
We retrospectively reviewed data on 1121 patients who underwent curative distal gastrectomy and had pathologic stage of ≥ pT2 or pN+. The patients were categorized into the D1+ and D2 LND groups, and long-term survival was compared in the original and propensity score matching (PSM) cohorts.
Overall, 909 and 212 patients underwent D2 and D1+ LND, respectively. The D2 group showed more advanced stage and more frequently underwent open surgery. Postoperative morbidity was significantly higher in the D2 group (19.5% vs. 13.2%, p = 0.034); however, mortality or ≥ grade III complications did not significantly differ between the groups. The 5-year overall survival (OS) and disease-free survival (DFS) did not significantly differ between D2 and D1+ groups at the same stage. Multivariate analysis of prognostic factors revealed that the extent of LND did not significantly affect survival, after adjusting for tumor stage and other clinicopathological factors. In the PSM cohort, the D2 and D1 groups showed no significant difference in OS (p = 0.488) and DFS (p = 0.705).
Long-term survival with D1+ LND was comparable to that with D2 LND for ≥ pT2 or pN + gastric carcinoma. A large randomized trial is warranted to validate the optimal extent of LND for gastric carcinoma.
D2 淋巴结清扫术（LND）作为治疗进展期胃癌（AGC）的标准手术方式被广泛应用。然而，D2 较 D1+LND 对胃癌治疗更优的证据有限。本研究比较了 D2 和 D1+LND 治疗 AGC 的长期疗效。
回顾性分析了 1121 例行根治性远端胃切除术且病理分期为≥pT2 或 pN+的患者资料。患者被分为 D1+和 D2 LND 两组，比较原始队列和倾向评分匹配（PSM）队列的长期生存情况。
总体而言，909 例患者接受了 D2 清扫术，212 例患者接受了 D1+清扫术。D2 组分期更晚，更常采用开腹手术。D2 组术后并发症发生率显著高于 D1+组（19.5%比 13.2%，p=0.034）；但两组死亡率或≥3 级并发症发生率无显著差异。在相同分期下，D2 和 D1+组的 5 年总生存（OS）和无病生存（DFS）无显著差异。多因素分析显示，在调整肿瘤分期和其他临床病理因素后，清扫范围对生存无显著影响。在 PSM 队列中，D2 组和 D1 组的 OS（p=0.488）和 DFS（p=0.705）无显著差异。
对于≥pT2 或 pN+的胃癌，D1+LND 的长期生存与 D2 LND 相当。需要开展大型随机试验来验证胃癌最佳的 LND 范围。
