Clinical study on the D4 lymph nodes excision in advanced gastric cancer

Abstract

AIM: To study the safety and the traumatic degree of D₄ approach by retrospective analysis of the para-operative data from the para-aortic lymph nodes excision in comparison with those from standard radical resection in advanced gastric cancer (AGC).

METHODS: Several para-operative data including the resectability, the mortality, the complicated morbidity, the amount of transfused blood, and the hospitalized days relating to the operation were analyzed statistically between D₄ (n = 30) and D₂ lymph nodes excision (n = 34) groups. The data expressed as means ± SD was analyzed statistically by Student’s t test. Percentage of the data was analyzed by χ² test statistically. It was taken as significant difference if P value was less than 0.05.

RESULTS: The percentage of palliated resection in D₄ group was significantly lower than that in D₂ group (16.67% vs 47.06%, P < 0.05). This D₄ radical resection would indeed prolong the drainage time (7.35 ± 0.98 d vs 14.78 ± 2.16 d, P < 0.01). The amount of transfused blood during operation (774.32 ± 112.09 mL) and the operative consuming time in D₄ group (7.14 ± 0.39 h) increased significantly too compared with those in D₂ group (538.67 ± 59.87 mL, P < 0.05; 4.12 ± 0.18 h, P < 0.05), suggesting that the dramatic degree of D₄ operation was severer than that of D₂ operation. But the mortality, the morbidity of complication and the hospitalized time after D₄ operation did not increase significantly, indicating that D₄ lymph nodes excision as a choice of the surgical treatment of AGC was safe and feasible.

CONCLUSION: D₄ lymph nodes excision for AGC is safe, reasonable and feasible.

Key Words: Stomach neoplasms/surgery, Lymph nodes excision, Complications