D2 lymphadenectomy is not only safe but necessary in the era of neoadjuvant chemotherapy

World Journal of Surgical Oncology

Mahesh Goel³  Shaesta Mehta²  Kunal Suradkar³  Somashekar Annaiah³  Kumar Vinchurkar³  Sanjay D Talole¹  Savio G Barreto³  Shailesh V Shrikhande³ 

[1] Department of Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, India;Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India;Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Mumbai, India

关键词: Neoadjuvant chemotherapy;    Mortality;    Morbidity;    Gastric cancer;    Gastrectomy;    D2 lymphadenectomy;   

Others  :  826375
DOI  :  10.1186/1477-7819-11-31

 received in 2012-11-26, accepted in 2013-01-18,  发布年份 2013

【 摘 要 】

Background

Patients with locally advanced resectable gastric cancers are increasingly offered neoadjuvant chemotherapy (NACT) following the MAGIC and REAL-2 trials. However, information on the toxicity of NACT, its effects on perioperative surgical outcomes and tumor response is not widely reported in literature.

Methods

Analysis of a prospective database of gastric cancer patients undergoing radical D2 gastrectomy over 2 years was performed. Chemotherapy-related toxicity, perioperative outcomes and histopathological responses to NACT were analyzed. The data is presented and compared to a cohort of patients undergoing upfront surgery in the same time period.

Results

In this study, 139 patients (42 female and 97 male patients, median age 53 years) with gastric adenocarcinoma received NACT. Chemotherapy-related toxicity was noted in 32% of patients. Of the 139 patients, 129 underwent gastrectomy with D2 lymphadenectomy, with 12% morbidity and no mortality. Major pathological response of primary tumor was noted in 22 patients (17%). Of these 22 patients, lymph node metastases were noted in 12 patients. The median blood loss and lymph node yield was not significantly different to the 62 patients who underwent upfront surgery. Patients who underwent upfront surgery were older (58 vs. 52 years, P <0.02), had a higher number of distal cancers (63% vs. 82%, P <0.015) and a longer hospital stay (11 vs. 9 days, P <0.001).

Conclusions

Perioperative outcomes of gastrectomy with D2 lymphadenectomy for locally advanced, resectable gastric cancer were not influenced by NACT. The number of lymph nodes harvested was unaltered by NACT but, more pertinently, metastases to lymph nodes were noted even in patients with a major pathological response of the primary tumor. D2 lymphadenectomy should be performed in all patients irrespective of the degree of response to NACT.

【 授权许可】

   
2013 Shrikhande et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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