D2 lymphectomy in the treatment of gastric cancer: A retrospective view onour experience (1990-1997)

From 1990 to 1997 we observed, in our departement, 267 patients affected by gastric cancer. In the first four years of our experience (1990-93) we res ected 87 patients out of 136 gastric cancers observed (63.9%): 56 pts. (64. 4%) were classified as ASA I-II, 21 (24.1%) as ASA III, 10 (11.5%) as ASA T V. In 2 cases (2.3%), operated in emergency, a D0-1 lymphectomy was perform ed, with a mean of 4 nodes resected; 67 pts. (77.0%) had a D2, with a mean of 36.5 nodes resected; in 18 pts. (20.7%) we performed a D3, with a mean o f 64.3 nodes resected. Post-operative technical complications were 13 (14.9 %). We observed 5 post-operatory deaths (5.7%), 3 due to technical complica tions. Absolutely and relatively curative resections have been 62 (71.3%). In the second period (1994-97) we resected 89/131 patients (67.9%): in this group 50 pts. (56.2%) were classified as ASA I-II, 24 (26.9%) as ASA III, 15 (16.9%) as ASA TV. With the exception of 3 patients (3.4%) who were oper ated in emergency (D0-1 procedures, with a mean number of 2.3 nodes resecte d) we adopted D2 lymphadenectomy plus hepatic peduncle as the procedure of choice, performed in 86 pts. (96.6%), with a mean of 34.1 nodes resected. P ost-operative technical complications were 5 (5.6%). We observed 5 post-ope ratory deaths (5.6%), 1 due to technical problems. Absolutely and relativel y curative resections have been 76 (85.4%), Morbidity and mortality due to technical complications in the second period are lower than observed in the first period, without any difference in the curability rate. D2 lymphectom y seems to be an effective procedure, safe even in high anesthesiological r isk patients. Increasing experience and standardization of the technique re duced risk of surgical complications and mortality.