Although curative resection is the treatment of choice for gastric
cancer, controversy exists about the adequate extent of lymph node dissection
when resection is performed. METHODS: We retrospectively assessed 85 patients who
underwent a limited lymphadenectomy (D1) and 71 who had an extended lymph node
dissection (D2) in a single institution between 1990 and 1998 (median follow-up,
37.3 months). Prognostic factors were assessed by Cox proportional hazard models
adjusted for potential confounders. RESULTS: We found no significant difference
in the length of hospital stay (median, 12.1 and 13.1 days), overall morbidity
(48.2% and 53.5%), or operative mortality (2.3% and 0%) between D1 and D2,
respectively. Five-year survival in the D2 group was longer (50.6%) than in the
D1 group (41.4%) for tumor stages (tumor-node-metastasis) >I. In multivariate
analysis, tumor-node-metastasis stage (hazard ratio for stages >I vs. 0-I, 11.6),
the ratio between invaded and removed lymph nodes, the presence of distant
metastases, Lauren classification, and the extent of lymphadenectomy (hazard
ratio for D1 vs. D2, 2.3; 95% confidence interval, 1.25-4.30) were the only
significant prognostic factors. CONCLUSIONS: Our experience shows that extended
(D2) lymph node dissection improves survival in patients with resected gastric
cancer
