TY - JOUR
T1 - Extended lymphadenectomy in elderly and/or highly co-morbid gastric cancer patients: A retrospective multicenter study
AU - Rausei, S.
AU - Ruspi, L.
AU - Rosa, F.
AU - Morgagni, P.
AU - Marrelli, D.
AU - Cossu, A.
AU - Cananzi, F.C.M.
AU - Lomonaco, R.
AU - Coniglio, A.
AU - Biondi, A.
AU - Cipollari, C.
AU - Graziosi, L.
AU - Fumagalli, U.
AU - Casella, F.
AU - Bertoli, P.
AU - di Leo, A.
AU - Alfieri, S.
AU - Vittimberga, G.
AU - Roviello, F.
AU - Orsenigo, E.
AU - Quagliuolo, V.
AU - Montemurro, S.
AU - Baiocchi, G.
AU - Persiani, R.
AU - Bencivenga, M.
AU - Donini, A.
AU - Rosati, R.
AU - Sansonetti, A.
AU - Ansaloni, L.
AU - Zanoni, A.
AU - Galli, F.
AU - Dionigi, G.
PY - 2016/12/1
Y1 - 2016/12/1
N2 - Background Gastrectomy with extended lymphadenectomy is considered the gold standard treatment for advanced gastric cancer, with no age- or comorbidity-related limitations. We evaluated the safety and efficacy of curative gastrectomy with extended nodal dissection, verifying survival in elderly and highly co-morbid patients. Methods In a retrospective multicenter study, we examined 1322 non-metastatic gastric-cancer patients that underwent curative gastrectomy with D2 versus D1 lymphadenectomy from January 2000 to December 2009. Postoperative complications, overall survival (OS), and disease-specific survival (DSS) according to age and the Charlson Comorbidity Score were analyzed in relation to the extent of lymphadenectomy. Results Postoperative morbidity was 30.4%. Complications were more frequent in highly co-morbid elderly patients, and, although general morbidity rates after D2 and D1 lymphadenectomy were similar (29.9% and 33.2%, respectively), they increased following D2 in highly co-morbid elderly patients (39.6%). D2-lymphadenectomy significantly improved 5-year OS and DSS (48.0% vs. 37.6% in D1, p <0.001 and 72.6% vs. 58.1% in D1, p <0.001, respectively) in all patients. In elderly patients, this benefit was present only in 5-year DSS. D2 nodal dissection induced better 5-year OS and DSS rates in elderly patients with positive nodes (29.7% vs. 21.2% in D1, p = 0.008 and 47.5% vs. 30.6% in D1, p = 0.001, respectively), although it was present only in DSS when highly co-morbid elderly patients were considered. Conclusion Extended lymphadenectomy confirmed better survival rates in gastric cancer patients. Due to high postoperative complication rate and no significant improvement of the OS, D1 lymphadenectomy should be considered in elderly and/or highly co-morbid gastric cancer patients.
AB - Background Gastrectomy with extended lymphadenectomy is considered the gold standard treatment for advanced gastric cancer, with no age- or comorbidity-related limitations. We evaluated the safety and efficacy of curative gastrectomy with extended nodal dissection, verifying survival in elderly and highly co-morbid patients. Methods In a retrospective multicenter study, we examined 1322 non-metastatic gastric-cancer patients that underwent curative gastrectomy with D2 versus D1 lymphadenectomy from January 2000 to December 2009. Postoperative complications, overall survival (OS), and disease-specific survival (DSS) according to age and the Charlson Comorbidity Score were analyzed in relation to the extent of lymphadenectomy. Results Postoperative morbidity was 30.4%. Complications were more frequent in highly co-morbid elderly patients, and, although general morbidity rates after D2 and D1 lymphadenectomy were similar (29.9% and 33.2%, respectively), they increased following D2 in highly co-morbid elderly patients (39.6%). D2-lymphadenectomy significantly improved 5-year OS and DSS (48.0% vs. 37.6% in D1, p <0.001 and 72.6% vs. 58.1% in D1, p <0.001, respectively) in all patients. In elderly patients, this benefit was present only in 5-year DSS. D2 nodal dissection induced better 5-year OS and DSS rates in elderly patients with positive nodes (29.7% vs. 21.2% in D1, p = 0.008 and 47.5% vs. 30.6% in D1, p = 0.001, respectively), although it was present only in DSS when highly co-morbid elderly patients were considered. Conclusion Extended lymphadenectomy confirmed better survival rates in gastric cancer patients. Due to high postoperative complication rate and no significant improvement of the OS, D1 lymphadenectomy should be considered in elderly and/or highly co-morbid gastric cancer patients.
KW - Elderly
KW - Gastric cancer
KW - High morbidity
KW - Lymphadenectomy
KW - Tailored treatment
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U2 - 10.1016/j.ejso.2016.05.003
DO - 10.1016/j.ejso.2016.05.003
M3 - Article
SN - 0748-7983
VL - 42
SP - 1881
EP - 1889
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 12
ER -