Survival outcomes after D1 and D2 lymphadenectomy with R0 resection in stage II–III gastric cancer: Longitudinal follow-up in a single center

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Objective: D2 lymphadenectomy (D2-LND) with curative resection (R0) is the cornerstone of gastric cancer treatment.In this study, we compared survival outcomes of D2-LDN with D1-LDN in patients who had undergone curativeresection for Stages II and III primary gastric adenocarcinoma.Material and Methods: Between April 1996 and March 2014, 153 consecutive patients with adenocarcinoma of thestomach underwent total gastrectomy with D1-LND or D2-LND. Among those, 118 patients (38 D1 vs. 80 D2) with acomplete history and having been followed for at least 1 year after surgery were enrolled.Both groups were comparedin terms of demographic and clinico-pathologic characteristics.Results: The mean follow-up was 42.6±52.5 months (mo.). The demographic characteristics of the groups weresimilar. The Tumor, Node and Metastases (TNM) stage distribution was 25% for Stage II and 75% for Stage III for bothgroups. Eighteen patients (47.4%) in the D1 and 47 patients (58.8%) in the D2 group were free from locoregionalrecurrence. The median disease-free survival was 22.0±4.1 mo. for the D1 and 28.0±4.3 mo. for the D2 group(p=0.36). Eight patients (21%) in the D1 and 39 patients (49%) in the D2 group were alive at the last follow-up. Themedian overall survival (OS) was 22.0±3.7 mo. for the D1 and 31.0±5.4 mo. for the D2 group (p=0.13). The 5-yeardisease-free survival and OS by the Kaplan–Meier estimates were 41% vs. 51% and 30% vs.42% in the D1 and D2groups, respectively. The median 5-year OS for patients with Stages IIIB and IIIC tumors was 14.0±2.2 mo.for the D1and 20.0±5.0 mo. for the D2 group, respectively (p: 0.048).Conclusion: When compared to D1-LND, D2-LND with R0 resection have yielded a trend toward a better outcome inpatients with primary gastric adenocarcinoma.