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. 1990 May;116(3):307–313. doi: 10.1007/BF01612909

A critical evaluation of effectivity of extended lymphadenectomy in patients with carcinoma of the stomach

An analysis of early results and long-term survival

Dimitrios H Roukos 1,✉, Christof Hottenrott 1, Mathias Lorenz 1, Steven Koutsogiorgas-Couchell 2
PMCID: PMC12201802  PMID: 2370254

Abstract

The therapeutic benefit of extended lymphade-nectomy in patients with gastric cancer is not generally accepted. We therefore analyzed the data of 82 patients with total gastrectomy and extended lymphadenectomy (compartment I: lymph nodes 1–6 and compartment II: lymph nodes 7–11) from 1979 to 1986 (GL group) for morbidity, mortality and survival and compared these with the results of a historical control group of 81 patients from 1971 to 1986 (group G), who similarly had undergone total gastrectomy but only compartment-I lymphadenectomy (lymph nodes 1–6). The 30-day operative mortality in the GL group was 6% (5/82), which was no higher than that of the control group (9.5%, 4/42) during the same observation period (1979–1986). The comparison of the actuarial survival according to the old TNM system (UICC 1978) in both groups showed no significant difference: stages I and II P=0.22, stage IIIP=0.29, all curative cases (stages I+II+III)P=0.12. In addition, the patients of the GL group were restaged according to the new TNM system (UICC 1987). The calculated 5-year survival rate in this group was: stage I, 89%; stage II, 64%; stage III, 21%; curative total (stages I+II+III), 62%; stage IV, 0%. All patients (n=12) with involvement and dissection of lymph nodes of compartment II died within 38 months. Only two of these patients (17%) had a potentially curative operation. Our results indicate that compartment-II lymph node dissection did not influence the operative mortality or the prognosis compared with compartment-I lymphadenectomy. Since patients with positive lymph nodes in compartment II did not benefit from the extended lymph node dissection of this area, obviously because of systemic spread, the question of the effectiveness of the extended lymphadenectomy remains unresolved.

Key words: Gastric carcinoma, Total gastrectomy, Lymphadenectomy, Mortality, Prognosis

References

  1. Baker R (1983) Argumente gegen die systematische Lymphadenektomie in der Behandlung von Patienten mit Magenkarzinom. In: Rohde H, Troidl H (Hrsg) Das Magenkarzinom. Thieme, Stuttgart, pp 165–169 [Google Scholar]
  2. Encke A, Seufert RM, Roukos D (1987) Kriterien und Therapie des kurablen Magenkarzinoms. In: Ketterer H (Hrsg) Speiseröhre-Magen. Schattauer, Stuttgart, pp 123–132 [Google Scholar]
  3. Gall FP, Hermanek P (1988) Die erweiterte Lymphknotendissektion beim Magen- und colorectalen Carcinom-Nutzen und Risiken. Chirurg 59:202–210 [PubMed] [Google Scholar]
  4. Heberer G, Teichmann PK, Kraemling HJ, Guenther B (1988) Results of gastric resection for carcinoma of the stomach: European experience. World J Surg 12:374–380 [DOI] [PubMed] [Google Scholar]
  5. Japanese Research Society for Gastric Cancer (JRSGC) (1981) The general rules for the gastric cancer study in surgery and pathology. Jpn J Surg 11:127–139 [DOI] [PubMed] [Google Scholar]
  6. Kaplan EL, Meier P (1958) Nonparametric estimation for incomplete observations. J Am Stat Assoc 53:457–481 [Google Scholar]
  7. Kodama Y, Sugimachi K, Soejima K, Matsusaka T, Inokuchi K (1981) Evaluation of extensive lymph node dissection for carcinoma of the stomach. World J Surg 5:241–248 [DOI] [PubMed] [Google Scholar]
  8. Longmire WP (1988) Invited commentary. World J Surg 12:380–381 [Google Scholar]
  9. Maruyama K (1983) Überlebenszeiten nach systematischer Lymph-adenektomie wegen Magenkarzinom. In: Rohde H, Troidl H (Hrsg) Das Magenkarzinom. Georg Thieme, Stuttgart, pp 183–186 [Google Scholar]
  10. Maruyama K, Okabayashi K, Kinoshita T (1986) Radical operation for advanced cancer. In: Gastric cancer surgery (the latest therapy), vol 3. Igaku Kyoiku Shuppan, Tokyo, pp 376–383 [Google Scholar]
  11. Maruyama K, Okabayashi K, Kinoshita T (1987) Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg 11:418–425 [DOI] [PubMed] [Google Scholar]
  12. Mishima Y, Hirayama R (1987) The role of lymph node surgery in gastric cancer. World J Surg 11: 406–411 [DOI] [PubMed] [Google Scholar]
  13. Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV, Mante N, McPherson K, Peto J, Smith PG (1977) Design and analysis of randomised clinical trials requiring prolonged observation of each patient. Br J Cancer 35:1–39 [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Schlag P, Buhl V, Moeller P, Herfarth Ch (1989) Die neue TNM-Klassifizierung und ihre Auswirkung auf die chirurgische Behandlung des Magenkarzinoms. Chirurg 60:8–15 [PubMed] [Google Scholar]
  15. Siewert JR, Lange J, Boettcher K, Becker K, Stier A (1986) Lymphadenektomie beim Magenkarzinom. Langenbecks Arch Chir 368:137–148 [DOI] [PubMed] [Google Scholar]
  16. Soga J, Ohyama S, Miyashita K, Suzuki T, Nashimoto A, Tanaka O (1988) A statistical evaluation of advancement in gastric cancer surgery with special reference to the significance of lymphadenectomy for cure. World J Surg 12:398–405 [DOI] [PubMed] [Google Scholar]
  17. UICC (1987) TNM classification of malignant tumors. Hermanek P, Sobin LH (eds) 4. Fully revised edition. Springer, Berlin Heidelberg New York [Google Scholar]
  18. Roukos D, Lorenz M, Hottenrott Ch (1988) Operative Behandlung und Prognose des Magenkarzinoms unter besonderer Berücksichtigung der Gastrektomie als Regeloperation. Schweiz Med Wochenschr 118:783–786 [PubMed] [Google Scholar]
  19. Roukos D, Lorenz M, Hottenrott Ch (1989 a) Prognostic relevance of Lauren classification in patients with gastric cancer. Schweiz Med Wochenschr 119:755–759 [PubMed] [Google Scholar]
  20. Roukos D, Hottenrott Ch, Lorenz M, Encke A (1989b) Gastric carcinoma-gastrectomy with or without splenectomy depending on tumour stage and localization. Aktuell Chir 1989b 24:96–101 [Google Scholar]

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