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Extent of lymphadenectomy has no impact on postoperative complications after gastric cancer surgery in Sweden

Kung, Chih Han; Song, Huan; Ye, Weimin; Nilsson, Magnus LU ; Johansson, Jan LU ; Rouvelas, Ioannis; Irino, Tomoyuki; Lundell, Lars; Tsai, Jon A. and Lindblad, Mats (2017) In Chinese Journal of Cancer Research 29(4). p.313-322
Abstract

Objective: Curative gastric cancer surgery entails removal of the primary tumor with adequate margins including regional lymph nodes. European randomized controlled trials with recruitment in the 1990’s reported increased morbidity and mortality for D2 compared to D1. Here, we examined the extent of lymphadenectomy during gastric cancer surgery and the associated risk for postoperative complications and mortality using the strengths of a population-based study. Methods: A prospective nationwide study conducted within the National Register of Esophageal and Gastric Cancer. All patients in Sweden from 2006 to 2013 who underwent gastric cancer resections with curative intent were included. Patients were categorized into D0, D1, or D1+/D2,... (More)

Objective: Curative gastric cancer surgery entails removal of the primary tumor with adequate margins including regional lymph nodes. European randomized controlled trials with recruitment in the 1990’s reported increased morbidity and mortality for D2 compared to D1. Here, we examined the extent of lymphadenectomy during gastric cancer surgery and the associated risk for postoperative complications and mortality using the strengths of a population-based study. Methods: A prospective nationwide study conducted within the National Register of Esophageal and Gastric Cancer. All patients in Sweden from 2006 to 2013 who underwent gastric cancer resections with curative intent were included. Patients were categorized into D0, D1, or D1+/D2, and analyzed regarding postoperative morbidity and mortality using multivariable logistic regression. Results: In total, 349 (31.7%) patients had a D0, 494 (44.9%) D1, and 258 (23.4%) D1+/D2 lymphadenectomy. The 30-d postoperative complication rates were 25.5%, 25.1% and 32.2% (D0, D1 and D1+/D2, respectively), and 90-d mortality rates were 8.3%, 4.3% and 5.8%. After adjustment for confounders, in multivariable analysis, there were no significant differences in risk for postoperative complications between the lymphadenectomy groups. For 90-d mortality, there was a lower risk for D1 vs. D0. Conclusions: The majority of gastric cancer resections in Sweden have included only a limited lymphadenectomy (D0 and D1). More extensive lymphadenectomy (D1+/D2) seemed to have no impact on postoperative morbidity or mortality.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Complications, Gastric cancer, Lymphadenectomy, Mortality, National database
in
Chinese Journal of Cancer Research
volume
29
issue
4
pages
10 pages
publisher
Beijing Institute for Cancer Research
external identifiers
  • scopus:85028457212
ISSN
1000-9604
DOI
10.21147/j.issn.1000-9604.2017.04.04
language
English
LU publication?
yes
id
931af2ef-bbc2-4b2a-915e-40131955bfbf
date added to LUP
2018-01-25 14:12:22
date last changed
2019-05-14 04:30:59
@article{931af2ef-bbc2-4b2a-915e-40131955bfbf,
  abstract     = {<p>Objective: Curative gastric cancer surgery entails removal of the primary tumor with adequate margins including regional lymph nodes. European randomized controlled trials with recruitment in the 1990’s reported increased morbidity and mortality for D2 compared to D1. Here, we examined the extent of lymphadenectomy during gastric cancer surgery and the associated risk for postoperative complications and mortality using the strengths of a population-based study. Methods: A prospective nationwide study conducted within the National Register of Esophageal and Gastric Cancer. All patients in Sweden from 2006 to 2013 who underwent gastric cancer resections with curative intent were included. Patients were categorized into D0, D1, or D1+/D2, and analyzed regarding postoperative morbidity and mortality using multivariable logistic regression. Results: In total, 349 (31.7%) patients had a D0, 494 (44.9%) D1, and 258 (23.4%) D1+/D2 lymphadenectomy. The 30-d postoperative complication rates were 25.5%, 25.1% and 32.2% (D0, D1 and D1+/D2, respectively), and 90-d mortality rates were 8.3%, 4.3% and 5.8%. After adjustment for confounders, in multivariable analysis, there were no significant differences in risk for postoperative complications between the lymphadenectomy groups. For 90-d mortality, there was a lower risk for D1 vs. D0. Conclusions: The majority of gastric cancer resections in Sweden have included only a limited lymphadenectomy (D0 and D1). More extensive lymphadenectomy (D1+/D2) seemed to have no impact on postoperative morbidity or mortality.</p>},
  author       = {Kung, Chih Han and Song, Huan and Ye, Weimin and Nilsson, Magnus and Johansson, Jan and Rouvelas, Ioannis and Irino, Tomoyuki and Lundell, Lars and Tsai, Jon A. and Lindblad, Mats},
  issn         = {1000-9604},
  keyword      = {Complications,Gastric cancer,Lymphadenectomy,Mortality,National database},
  language     = {eng},
  month        = {08},
  number       = {4},
  pages        = {313--322},
  publisher    = {Beijing Institute for Cancer Research},
  series       = {Chinese Journal of Cancer Research},
  title        = {Extent of lymphadenectomy has no impact on postoperative complications after gastric cancer surgery in Sweden},
  url          = {http://dx.doi.org/10.21147/j.issn.1000-9604.2017.04.04},
  volume       = {29},
  year         = {2017},
}