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Lymphadenectomy—D1, D2, and D3

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Gastric Cancer

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Abstract

The Japanese Research Society for Gastric Cancer has defined 16 lymph node stations surrounding the stomach, and developed different types of lymphadenectomy. In several randomized studies, the extent of lymph node dissection in gastric cancer has been studied, and based on these trials both Asian and Western guidelines now recommend a D2 lymph node dissection for advanced gastric cancer. In the majority of these studies, distal pancreatectomy and splenectomy were associated with increased morbidity and mortality, and therefore these procedures are not recommended to perform routinely. As outcomes after gastrectomy are strongly dependent on surgical quality, both centralization of surgery and auditing programs are used to improve outcomes on a national level.

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References

  1. Okines A, Verheij M, Allum W, Cunningham D, Cervantes A. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(Suppl 5):v50–4.

    Google Scholar 

  2. Ajani JA, Barthel JS, Bekaii-Saab T, et al. Gastric cancer. J Natl Compr Canc Netw. 2010;8:378–409.

    CAS  PubMed  Google Scholar 

  3. Japanese Research Society for Gastric Cancer. Japanese classification of gastric carcinoma, First English ed.: Kanehara & Co., Ltd.; 1995.

    Google Scholar 

  4. Japanese Gastric Cancer Association. Japanese Classification of gastric carcinoma—2nd English edition. Gastric Cancer 1998;1:10–24.

    Article  PubMed  Google Scholar 

  5. Kampschoer GHM, Sasako M, Wetselaar-Whittaker J. Surgical treatment of gastric cancer. Leiden: Leiden University; 1989.

    Google Scholar 

  6. Allum WH, Powell DJ, McConkey CC, Fielding JW. Gastric cancer: a 25-year review. Br J Surg. 1989;76:535–40.

    Article  CAS  PubMed  Google Scholar 

  7. Dent DM, Madden MV, Price SK. Randomized comparison of R1 and R2 gastrectomy for gastric carcinoma. Br J Surg. 1988;75:110–2.

    Article  CAS  PubMed  Google Scholar 

  8. Robertson CS, Chung SC, Woods SD, et al. A prospective randomized trial comparing R1 subtotal gastrectomy with R3 total gastrectomy for antral cancer. Ann Surg. 1994;220:176–82.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The surgical cooperative group. Lancet. 1996;347:995–9.

    Article  CAS  PubMed  Google Scholar 

  10. Cuschieri A, Weeden S, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer. 1999;79:1522–30.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Bonenkamp JJ, Songun I, Hermans J, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995;345:745–8.

    Article  CAS  PubMed  Google Scholar 

  12. Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med. 1999;340:908–14.

    Article  CAS  PubMed  Google Scholar 

  13. Hartgrink HH, van de Velde CJ, Putter H, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol. 2004;22:2069–77.

    Article  CAS  PubMed  Google Scholar 

  14. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11:439–49.

    Article  PubMed  Google Scholar 

  15. McCulloch P, Nita ME, Kazi H, Gama-Rodrigues J. Extended versus limited lymph nodes dissection technique for adenocarcinoma of the stomach. Cochrane Database Syst Rev. 2003;4:CD001964.

    PubMed  Google Scholar 

  16. Wu CW, Hsiung CA, Lo SS, Hsieh MC, Shia LT, Whang-Peng J. Randomized clinical trial of morbidity after D1 and D3 surgery for gastric cancer. Br J Surg. 2004;91:283–7.

    Article  CAS  PubMed  Google Scholar 

  17. Wu CW, Hsiung CA, Lo SS, et al. Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol. 2006;7:309–15.

    Article  CAS  PubMed  Google Scholar 

  18. Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy–Japan Clinical Oncology Group study 9501. J Clin Oncol. 2004;22:2767–73.

    Article  PubMed  Google Scholar 

  19. Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008;359:453–62.

    Article  CAS  PubMed  Google Scholar 

  20. Degiuli M, Sasako M, Ponti A. Morbidity and mortality in the Italian Gastric Cancer Study Group randomized clinical trial of D1 versus D2 resection for gastric cancer. Br J Surg. 2010;97:643–9.

    Article  CAS  PubMed  Google Scholar 

  21. Degiuli M, Sasako M, Ponti A, et al. Randomized clinical trial comparing survival after D1 or D2 gastrectomy for gastric cancer. Br J Surg. 2014;101:23–31.

    Article  CAS  PubMed  Google Scholar 

  22. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–23.

    Article  Google Scholar 

  23. Sasako M. Risk factors for surgical treatment in the Dutch Gastric Cancer Trial. Br J Surg. 1997;84:1567–71.

    Article  CAS  PubMed  Google Scholar 

  24. Hartgrink HH, Jansen EP, van Grieken NC, van de Velde CJ. Gastric cancer. Lancet. 2009;374:477–90.

    Article  PubMed  Google Scholar 

  25. Furukawa H, Hiratsuka M, Ishikawa O, et al. Total gastrectomy with dissection of lymph nodes along the splenic artery: a pancreas-preserving method. Ann Surg Oncol. 2000;7:669–73.

    Article  CAS  PubMed  Google Scholar 

  26. Csendes A, Burdiles P, Rojas J, Braghetto I, Diaz JC, Maluenda F. A prospective randomized study comparing D2 total gastrectomy versus D2 total gastrectomy plus splenectomy in 187 patients with gastric carcinoma. Surgery. 2002;131:401–7.

    Article  PubMed  Google Scholar 

  27. Yu W, Choi GS, Chung HY. Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer. Br J Surg. 2006;93:559–63.

    Article  CAS  PubMed  Google Scholar 

  28. Brar SS, Seevaratnam R, Cardoso R, Law C, Helyer L, Coburn N. A systematic review of spleen and pancreas preservation in extended lymphadenectomy for gastric cancer. Gastric Cancer. 2012;15(Suppl 1):S89–99.

    Article  PubMed  Google Scholar 

  29. Sano T, Yamamoto S, Sasako M, Japan Clinical Oncology Group Study LM. Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma: Japan clinical oncology group study JCOG 0110-MF. Jpn J Clin Oncol. 2002;32:363–4.

    Article  PubMed  Google Scholar 

  30. Hundahl SA, Macdonald JS, Benedetti J, Fitzsimmons T. Surgical treatment variation in a prospective, randomized trial of chemoradiotherapy in gastric cancer: the effect of undertreatment. Ann Surg Oncol. 2002;9:278–86.

    Article  PubMed  Google Scholar 

  31. Peeters KCMJ, Hundahl SA, Kranenbarg EK, Hartgrink H, Velde CJH. Low Maruyama index surgery for gastric cancer: Blinded reanalysis of the Dutch D1-D2 trial. World J Surg. 2005;29:1576–84.

    Article  CAS  PubMed  Google Scholar 

  32. Luft HS, Bunker JP, Enthoven AC. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med. 1979;301:1364–9.

    Article  CAS  PubMed  Google Scholar 

  33. Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37.

    Article  PubMed  Google Scholar 

  34. Callahan MA, Christos PJ, Gold HT, Mushlin AI, Daly JM. Influence of surgical subspecialty training on in-hospital mortality for gastrectomy and colectomy patients. Transactions of the Meeting of the American Surgical Association. Ann Surg. 2003;121:322–32.

    Google Scholar 

  35. Finlayson EV, Goodney PP, Birkmeyer JD. Hospital volume and operative mortality in cancer surgery: a national study. Arch Surg. 2003;138:721–5; discussion 6.

    Article  PubMed  Google Scholar 

  36. Hannan, E. The influence of hospital and surgeon volume on in-hospital mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer. Surgery. 2002;131:6–15.

    Article  PubMed  Google Scholar 

  37. Jensen LS, Nielsen H, Mortensen PB, Pilegaard HK, Johnsen SP. Enforcing centralization for gastric cancer in Denmark. Eur J Surg Oncol. 2010;36:S50–4.

    Article  PubMed  Google Scholar 

  38. Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Hospital volume and quality of laparoscopic gastrectomy in Japan. Dig Surg. 2009;26:422–9.

    Article  PubMed  Google Scholar 

  39. Learn PA, Bach PB. A decade of mortality reductions in major oncologic surgery: the impact of centralization and quality improvement. Med Care. 2010;48:1041–9.

    Article  PubMed  Google Scholar 

  40. Lin HC, Xirasagar S, Lee HC, Chai CY. Hospital volume and inpatient mortality after cancer-related gastrointestinal resections: the experience of an Asian country. Ann Surg Oncol. 2006;13:1182–8.

    Article  PubMed  Google Scholar 

  41. Nomura E, Tsukuma H, Ajiki W, Oshima A. Population-based study of relationship between hospital surgical volume and 5-year survival of stomach cancer patients in Osaka, Japan. Cancer Sci. 2003;94:998–1002.

    Article  CAS  PubMed  Google Scholar 

  42. Smith DL, Elting LS, Learn PA, Raut CP, Mansfield PF. Factors influencing the volume-outcome relationship in gastrectomies: a population-based study. Ann Surg Oncol. 2007;14:1846–52.

    Article  PubMed  Google Scholar 

  43. Xirasagar S, Lien YC, Lin HC, Lee HC, Liu TC, Tsai J. Procedure volume of gastric cancer resections versus 5-year survival. Eur J Surg Oncol. 2008;34:23–9.

    Article  CAS  PubMed  Google Scholar 

  44. Bachmann MO, Alderson D, Edwards D, et al. Cohort study in South and West England of the influence of specialization on the management and outcome of patients with oesophageal and gastric cancers. Br J Surg. 2002;89:914–22.

    Article  CAS  PubMed  Google Scholar 

  45. Birkmeyer JD, Sun Y, Wong SL, Stukel TA. Hospital volume and late survival after cancer surgery. Ann Surg. 2007;245:777–83.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Enzinger PC, Benedetti JK, Meyerhardt JA, et al. Impact of hospital volume on recurrence and survival after surgery for gastric cancer. Ann Surg. 2007;245:426–34.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Ioka A, Tsukuma H, Ajiki W, Oshima A. Hospital procedure volume and survival of cancer patients in Osaka, Japan: a population-based study with latest cases. Jpn J Clin Oncol. 2007;37:544–53.

    Article  PubMed  Google Scholar 

  48. Thompson AM, Rapson T, Gilbert FJ, Park KGM. Hospital volume does not influence long-term survival of patients undergoing surgery for oesophageal or gastric cancer. Br J Surg. 2007;94:578–84.

    Article  CAS  PubMed  Google Scholar 

  49. Wouters MW, Karim-Kos HE, le Cessie S, et al. Centralization of esophageal cancer surgery: does it improve clinical outcome? Ann Surg Oncol. 2009;16:1789–98.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  50. Birkmeyer JD, Sun Y, Goldfaden A, Birkmeyer NJO, Stukel TA. Volume and process of care in high-risk cancer surgery. Cancer. 2006;106:2476–81.

    Article  PubMed  Google Scholar 

  51. Sonnenday CJ, Birkmeyer JD. A tale of two provinces: regionalization of pancreatic surgery in Ontario and Quebec. Ann Surg Oncol. 2010;17:2535–6.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Leiden University Medical Center, K6-50, PO Box 9600, 2300, Leiden, RC, The Netherlands

    Johan L. Dikken MD, PhD & Henk H. Hartgrink MD, PhD

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  1. Johan L. Dikken MD, PhD
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  2. Henk H. Hartgrink MD, PhD
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Correspondence to Johan L. Dikken MD, PhD .

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Editors and Affiliations

  1. Gastric and Mixed Tumor Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    Vivian E. Strong

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Dikken, J., Hartgrink, H. (2015). Lymphadenectomy—D1, D2, and D3. In: Strong, V. (eds) Gastric Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-15826-6_13

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  • DOI: https://doi.org/10.1007/978-3-319-15826-6_13

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  • Publisher Name: Springer, Cham

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