Despite the existing controversy concerning the benefits of lymphadenectomy on the improvement of survival rates of patients submitted to curative ressections of gastric adenocarcinoma, it is undeniable that extended lymphadenectomy (level from japanese classification) helps staging and contributes to a more accurate prognosis of those patients. This procedure provides the opportunity to better select patients with the worse prognosis and offer them new forms of adjuvant therapy. Since the most important argument against a more radical surgery is a higher incidence of complications and mortality, the authors prospectively evaluated them by performing gastrectomies with systematic D2 lymphadenectomy in patients treated with curative intention. For this purpose, the authors studied mortality rates, operative time, blood transfusion, morbidity and hospital stay. Between december 1992 and february 1997, 86 patients were admitted for treatment of gastric adenocarcinoma: 27 of them were seen by the same surgical team and underwent a curative operative procedure had an operative procedure, gastrectomy with D2 lymphadenectomy. Subtotal gastrectomy was performed in 17 patients and total gastrectomy in 10. Nine patients had superficial tumors. There were no deaths related to D2 dissection. Operative mean time was 208.7 minutes. Patients received a mean of O.2 units of blood transfusion: complications were observed in 33.3% and mean hospital stay was 8.6 days after surgery. Eight hundred and fifty four lymphonodes were sampled and 22.1% of them had metastatic tumor. The authors conclude that D2 lymphadenectomy: He can be done safely and should not be avoided based on concerns of complications. It sure leads to a more accurate pathologic staging and better prognosis analysis for those patients.
Gastric cancer; Adenocarcinoma; Lymphadenectomy; Morbidity; Mortality