Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2015; 21(47): 13294-13301
Published online Dec 21, 2015. doi: 10.3748/wjg.v21.i47.13294
Surgical care quality and oncologic outcome after D2 gastrectomy for gastric cancer
Johanna Mrena, Anne Mattila, Jan Böhm, Ismo Jantunen, Ilmo Kellokumpu
Johanna Mrena, Anne Mattila, Ilmo Kellokumpu, Department of Surgery, Central Hospital of Central Finland, 40620 Jyväskylä, Finland
Jan Böhm, Department of Pathology, Central Hospital of Central Finland, 40620 Jyväskylä, Finland
Ismo Jantunen, Department of Oncology, Central Hospital of Central Finland, 40620 Jyväskylä, Finland
Author contributions: Mrena J, Mattila A, Böhm J, Jantunen I and Kellokumpu I participated in the design of the study, acquisition of data, and article revisions; Kellokumpu I and Mrena J analyzed the data and wrote the article; all authors have approved the final version of the article.
Supported by the Central Hospital of Central Finland.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Central Hospital of Central Finland.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by verbal consent. Individuals can’t be identified according to the data presented.
Conflict-of-interest statement: This work was presented as a poster at the ISW Congress in Helsinki, Finland, August 25-29, 2013. We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Johanna Mrena, MD, PhD, Department of Surgery, Central Hospital of Central Finland, Keskussairaalantie 19, 40620 Jyväskylä, Finland.
Telephone: +358-14-2695048 Fax: +358-14-2692929
Received: May 29, 2015
Peer-review started: June 3, 2015
First decision: July 19, 2015
Revised: August 17, 2015
Accepted: October 23, 2015
Article in press: October 26, 2015
Published online: December 21, 2015

AIM: To examine the quality of surgical care and long-term oncologic outcome after D2 gastrectomy for gastric cancer.

METHODS: From 1999 to 2008, a total of 109 consecutive patients underwent D2 gastrectomy without routine pancreaticosplenectomy in a multimodal setting at our institution. Oncologic outcomes together with clinical and histopathologic data were analyzed in relation to the type of surgery performed. Staging was carried out according to the Union for International Cancer Control criteria of 2002. Patients were followed-up for five years at the outpatient clinic. The primary measure of outcome was long-term survival with the quality of surgery as a secondary outcome measure. Clinical data were retrospectively collected from the patient records, and causes of death were obtained from national registries.

RESULTS: A total of 109 patients (58 men) with a mean age of 67.4 ± 11.2 years underwent total gastrectomy or gastric resection with D2 lymph node dissection. The tumor stage distribution was as follows: stage I, (27/109) 24.8%; stage II, (31/109) 28.4%; stage III, (41/109) 37.6%; and stage IV, (10/109) 9.2%. Forty patients (36.7%) received chemotherapy or chemoradiotherapy. The five-year overall survival rate for all 109 patients was 45.0%, and was 47.1% for the 104 patients treated with curative R0 resection. The five-year disease-specific survival rates were 53.0% and 55.8%, respectively. In a multivariate analysis, body mass index and tumor stage were independent prognostic factors for overall survival (both P < 0.01), whereas body mass index, tumor stage, tumor site, Lauren classification, and lymph node invasion were prognostic factors for cancer-specific survival (all P < 0.05). Postoperative 30-d mortality was 1.8% and 30-d, surgical (including three anastomotic leaks, two of which were treated conservatively), and general morbidities were 26.6%, 12.8%, and 14.7%, respectively.

CONCLUSION: D2 dissection is a safe surgical option for gastric cancer, providing quality surgical care and long-term oncologic outcomes that are in line with current Western standards.

Keywords: Gastric cancer, Quality of care, Survival, Gastric surgery, Clinical practice

Core tip: Gastric cancer remains one of the most lethal malignancies worldwide. Although radical surgery with adequate lymphadenectomy is the cornerstone of curative treatment, whether D2 lymphadenectomy is applicable in Western hospitals is not clear, despite the low reported morbidity and mortality rates and survival benefit. This single-center study of 109 patients demonstrates that D2 lymphadenectomy can be performed with relatively low mortality (1.8%) and morbidity (26.6%). Five-year survival rates were 45.0% (overall) and 53.0% (disease-specific). Therefore, D2 gastrectomy can be considered as a safe surgical option for gastric cancer.