The effect of D3 dissection on postoperative morbidity and early mortality in gastric cancer patients who underwent curative total gastrectomy

Abstract

AIM: The present study presents the factors associated with early complications and mortality in patients undergoing total gastrectomy.

MATERIAL AND METHOD: The study included patients who underwent curative total gastrectomy for gastric adenocarcinoma between January 2001 and December 2016 in the General Surgery Department of the Çukurova University Medical Faculty Hospital. The patients were divided into D1, D2, and D3 groups depending on the lymph node dissection width, and the demographic and clinical data and mortality were compared. In addition, mortality-associated factors were analyzed.

RESULTS: The study sample included 148 (62.7%) males and 88 (37.3%) females, with a mean age of 65.5±11.4 years. There were 87 patients in the D1 group, 117 in the D2 group, and 23 in the D3 group. As expected, the duration of the operation was longer in the D2 and D3 groups (179 vs. 224 vs. 252; p<0.001), and these groups had also higher numbers of lymph nodes dissected (8 vs. 20 vs. 32; p<0.001) and metastatic lymph nodes (2.6 vs. 7.5 vs. 9.2; p<0.001). The analysis of the operation type in terms of complications revealed a significant relationship only with stump blowout, which was significantly more common after D3 dissection than following D2 and D1 dissections (p:0.01). The male gender (87.5 vs 60.9 p:0.03) was more associated with mortality.

CONCLUSION: D1, D2 and D3 Lymph node dissection in gastric cancer surgery can be safely performed with low mortality and morbidity rates by surgeons with sufficient technical knowledge, and in centers with sufficient hospital volume