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Previous Volume 340:908-914 March 25, 1999 Number 12 Next

	Full Text PDF Editorial by Brennan, M. F. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Curative resection is the treatment of choice for gastric cancer, but it is unclear whether this operation should include an extended (D2) lymph-node dissection, as recommended by the Japanese medical community, or a limited (D1) dissection. We conducted a randomized trial in 80 Dutch hospitals in which we compared D1 with D2 lymph-node dissection for gastric cancer in terms of morbidity, postoperative mortality, long-term survival, and cumulative risk of relapse after surgery.

Methods Between August 1989 and July 1993, a total of 996 patients entered the study. Of these patients, 711 (380 in the D1 group and 331 in the D2 group) underwent the randomly assigned treatment with curative intent, and 285 received palliative treatment. The procedures for quality control included instruction and supervision in the operating room and monitoring of the pathological results.

Results Patients in the D2 group had a significantly higher rate of complications than did those in the D1 group (43 percent vs. 25 percent, P<0.001), more postoperative deaths (10 percent vs. 4 percent, P= 0.004), and longer hospital stays (median, 16 vs. 14 days; P<0.001). Five-year survival rates were similar in the two groups: 45 percent for the D1 group and 47 percent for the D2 group (95 percent confidence interval for the difference, –9.6 percent to +5.6 percent). The patients who had R0 resections (i.e., who had no microscopical evidence of remaining disease), excluding those who died postoperatively, had cumulative risks of relapse at five years of 43 percent with D1 dissection and 37 percent with D2 dissection (95 percent confidence interval for the difference, –2.4 percent to +14.4 percent).

Conclusions Our results in Dutch patients do not support the routine use of D2 lymph-node dissection in patients with gastric cancer.

Source Information

From the Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands (J.J.B., C.J.H.V.), the Department of Medical Statistics, Leiden University, Leiden, the Netherlands (J.H.), and the National Cancer Center Hospital, Tokyo, Japan (M.S.). Other authors were K. Welvaart and I. Songun (Leiden University Medical Center); S. Meyer (University Hospital Amsterdam Vrije University); J.T.M. Plukker (University Hospital Groningen); P. Van Elk (Geertruiden Hospital Deventer); H. Obertop, D.J. Gouma, J.J.B. van Lanschot, and C.W. Taat (Amsterdam Academic Medical Center); P.W. de Graaf (Reinier de Graaf Hospital Delft); M.F. von Meyenfeldt (University Hospital Maastricht); and H. Tilanus (University Hospital Dijkzigt Rotterdam) — all in the Netherlands.

Address reprint requests to Prof. van de Velde at the Department of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands, or at velde{at}surgery.azl.nl.

Full Text of this Article

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Surgery for Gastric Cancer
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Extract | Full Text  
N Engl J Med 1999; 341:538-539, Aug 12, 1999. Correspondence

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