Extended lymphadenectomy in elderly and/or highly co-morbid gastric cancer patients: A retrospective multicenter study.

Abstract

BACKGROUND:

Gastrectomy with extended lymphadenectomy is considered the gold standard treatment for advanced gastric cancer, with no age- or comorbidity-related limitations. We evaluated the safety and efficacy of curative gastrectomy with extended nodal dissection, verifying survival in elderly and highly co-morbid patients.

METHODS:

In a retrospective multicenter study, we examined 1322 non-metastatic gastric-cancer patients that underwent curative gastrectomy with D2 versus D1 lymphadenectomy from January 2000 to December 2009. Postoperative complications, overall survival (OS), and disease-specific survival (DSS) according to age and the Charlson Comorbidity Score were analyzed in relation to the extent of lymphadenectomy.

RESULTS:

Postoperative morbidity was 30.4%. Complications were more frequent in highly co-morbid elderly patients, and, although general morbidity rates after D2 and D1 lymphadenectomy were similar (29.9% and 33.2%, respectively), they increased following D2 in highly co-morbid elderly patients (39.6%). D2-lymphadenectomy significantly improved 5-year OS and DSS (48.0% vs. 37.6% in D1, p < 0.001 and 72.6% vs. 58.1% in D1, p < 0.001, respectively) in all patients. In elderly patients, this benefit was present only in 5-year DSS. D2 nodal dissection induced better 5-year OS and DSS rates in elderly patients with positive nodes (29.7% vs. 21.2% in D1, p = 0.008 and 47.5% vs. 30.6% in D1, p = 0.001, respectively), although it was present only in DSS when highly co-morbid elderly patients were considered.

CONCLUSION:

Extended lymphadenectomy confirmed better survival rates in gastric cancer patients. Due to high postoperative complication rate and no significant improvement of the OS, D1 lymphadenectomy should be considered in elderly and/or highly co-morbid gastric cancer patients.

• Authors: S Rausei, L Ruspi, F Rosa, P Morgagni, D Marrelli, A Cossu, F C M Cananzi, R Lomonaco, A Coniglio, A Biondi, C Cipollari, L Graziosi, U Fumagalli, F Casella, P Bertoli, A di Leo, S Alfieri, G Vittimberga, F Roviello, E Orsenigo, V Quagliuolo, S Montemurro, G Baiocchi, R Persiani, M Bencivenga, A Donini, R Rosati, A Sansonetti, L Ansaloni, A Zanoni, F Galli, G Dionigi, Italian Research Group for Gastric Cancer (IRGGC)
• Journal: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Eur J Surg Oncol) Vol. 42 Issue 12 Pg. 1881-1889 (Dec 2016) ISSN: 1532-2157 [Electronic] England
• PMID: 27266816 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2016 Elsevier Ltd. All rights reserved.

Topics

• Adenocarcinoma (epidemiology, surgery)
• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Cardiovascular Diseases (epidemiology)
• Comorbidity
• Dementia (epidemiology)
• Diabetes Mellitus (epidemiology)
• Disease-Free Survival
• Female
• Gastrectomy (methods)
• Humans
• Liver Diseases (epidemiology)
• Lymph Node Excision (methods)
• Male
• Middle Aged
• Postoperative Complications (epidemiology)
• Pulmonary Disease, Chronic Obstructive (epidemiology)
• Retrospective Studies
• Stomach Neoplasms (epidemiology, surgery)
• Survival Rate