MORBIDITY AND MORTALITY AFTER D2 GASTRECTOMY FOR GASTRIC-CANCER - RESULTS OF THE ITALIAN GASTRIC-CANCER STUDY-GROUP PROSPECTIVE MULTICENTERSURGICAL STUDY

Purpose: To investigate whether pancreas preservation together with a strict quality-control system could ameliorate the outcome of D2 resec tions for gastric cancer in Western patients. Patients and Methods: It alian patients with potentially curable proven adenocarcinoma of the s tomach were registered from nine general and/or university hospitals i n the area of Turin, Northern Italy The study was performed according to the guidelines of the Japanese Research Society for Gastric Cancer (JRSGC). A strict quality-control system was guaranteed by a supervisi ng surgeon of the reference center, who had stayed at the National Can cer Center Hospital, Tokyo, to learn the standard D2 gastrectomy. The standard procedure entailed removal of the level 1 and 2 lymph nodes. During total gastrectomy, the pancreas was preserved according to the Maruyama technique. Results: Between May 1994 and December 1996, 191 e ligible patients were entered onto the study. The mean number of lymph nodes removed was 39. The overall morbidity rate was 20.9%. Surgical complications were observed in 16.7% of patients. Reoperation wets nec essary in six patients and was always successful. The overall hospital mortality rate was 3.1%; it was higher after total gastrectomy (7.46% ) than after distal gastrectomy (0.8%). The average length of hospital stay was 17 days. Conclusion: Given that postoperative morbidity and mortality rates are favorably comparable with those reported after the Western standard gastrectomy, the more extensive Japanese procedure w ith pancreas preservation can be regarded as a safe radical treatment of gastric cancer for selected Western patients treated in experienced centers. (C) 1998 by American Society of Clinical Oncology.