Objectives: The present work aimed to evaluate short-term outcome of subtotal gastrectomy with D1 versus
D2 lymphadenectomy (LND) as a therapeutic modality for distal gastric carcinoma.
Patients &: Methods: The study included 35 patients; 25 males and 10 females with mean age of 66±11.4
years and had biopsy-confirmed distal gastric adenocarcinoma and assigned for gastrectomy. The extent of
resection was determined by tumor site, tumor stage, and growth pattern according to the Lauren classification.
Subtotal gastrectomy was performed with Billroth II technique for reconstruction. Lymph node dissection was
conducted and extirpation of >25 lymph nodes was classified as an extended (D2) LND and extirpation of <25
lymph nodes was defined as a standard (DI) LND. Surgical morbidity or mortality rate was defined as any
complication or deaths occurring in the 30-day postoperative (PO) period were reported.
Results : D1 LND was performed in 21 patients and D2 LND in 14 patients with a mean total number of
extirpated lymph nodes of 28.1±16; range: 5-62 LN. Histopathological examination of extirpated LN detected
metastasis in 143 LN out of the 983 excised LN with a total metastasis ratio of 0.15. Mean metastasis ratio was
significantly higher with D2 versus D1 LND. Three patients had gastrectomy plus splenectomy and 4 patients
had gastrectomy plus pancreaticosplenectomy with a significant increase of the frequency of the need for
extensive surgery with D2 LND. Mean duration of surgery was significantly longer and intraoperative blood
loss was significantly higher in D2 LND compared to D1 LND. Postoperative morbidity was recorded in 10
patients (28.6%) and 6 patients (17.1%) died with significantly higher frequency of PO morbidity and
mortality with D2 LND compared to D1 LND. There was a positive significant correlation between occurrence
of PO morbidity .and lesion size, number of excised LN, metastatic LN, intraoperative blood loss, operative time
and hospital stay. However, there was a positive significant correlation between PO mortality and number of
metastatic LN, metastatic ratio, intraoperative blood loss and operative time. Multi-variate regression analysis
defined number of excised LN as a significant independent factor for PO morbidity and metastatic ratio of LN as
a significant independent factor for PO mortality. Using ROC analysis, number of excised LN was defined as
the specific predictor for occurrence of PO morbidity with area under curve (A11(2) =0.824 and defined tile
metastatic ratio as specific predictor for PO mortality (ALI(2=0.871).
Conclusion : It could be concluded that subtotal gastrectomy with D1 lymphadenectomy is appropriate
surgical modality for patients with gastric carcinoma with significantly lower intraoperative and shot-term
postoperative morbidity and mortality compared to D2 lymphadenectomy. |
