Prognosis for Patients with Early Gastric Cancer Comparison of D1 vs D2 lymphadenectomy

Ryu, Keun Won; Mok, Young Jae; Kim, Seung Joo; Kim, Chong Suk

Abstract

PURPOSE: Early gastric cancer is now considered to be a curable disease, and its traditional treatment is a D2 lymphadenectomy. However, the low rate of lymph node metastasis, the recent developments of endoscopic and laparoscopic surgery, and concerns for postoperative quality of life have led to less invasive therapeutic options. The D1 lymphadenectomy is one such option, so we investigated its adequacy as a substitute for a D2 lymphadenectomy as a treatment modality for early gastric cancer by comparing the prognoses of the two approaches. METHODS: A retrospective analysis of the case histories of 332 patients who had received an operation for early gastric cancer at Korea University Guro Hospital from 1984 to 1997 was performed. These cases were divided into D1 and D2 groups, and the groups were compared on the basis of clinicopathologic features, operative procedures, and 5-year survival rates. RESULTS: The D1 group included 160 cases, and the D2 group had 172 cases. The D2 group included more distal one-third cancer (66.3% vs 51.9%), more submucosal tumors (51.2% vs 38.7%), and more dissected lymph nodes (31.1+/-12.8 vs 23.0+/-11.3) than the D1 group (p<0.05). The overall 5-year survival rate for the early gastric-cancer patients was 95.5%. The 5-year survival rate of the D1 group was 96.6%, and that of the D2 group was 94.1%, but this difference was not significant (p>0.05). When the tumor depth was considered, the 5-year survival rates of the D1 and the D2 groups were not significantly different for mucosal and submucosal tumors (p>0.05). CONCLUSION: A D2 lymphadenec tomy for early gastric cancer can harvest more lymph nodes, but it has no survival benefit over a D1 lymphadenectomy. The result of this retrospective study suggests that a D1 lymphadenectomy may be used as a replacement for a D2 lymphadectomy in early gastric-cancer surgery, although prospective randomized studies are needed.