Cancer of the stomach: impact of radical lymphadenectomy on results - A 20-year retrospective study.

Study aim: The aim of this retrospective study was to compare a group of pa tients who underwent resection for gastric adenocarcinoma (cancer of cardia excluded) and to assess the influence of radical lymphadenectomy on postop erative mortality and morbidity and 5-year survival rate. Patients and method: One hundred and six patients were operated on from 197 5 to 1985 and 99 from 1986 to 1995 for gastric adenocarcinoma located in th e distal portion of the stomach in 56 % and 61 % respectivaly and, undiffer enciated in 56 %. Gastric resection was a subtotal gastrectomy for cancers of the lower third and total gastrectomy for cancers of the middle and supe rior thirds. In the first group (1975-1985), a D1 lymphadenectomy was perfo rmed in all patients. In the second group (1986-1995) a D1.5 lymphadenectom y without systematic splenectomy and pancreatectomy was applied to 49 patie nts. Results: In the second group, the proportion of curative resection was high er (85 % versus 75 %) along with a higher rate of total gastrectomy (42 % v ersus 17 %). The postoperative mortality rate was 2 % in the first group an d 1 % in the second group. The morbidity rate was 33 % in the first group a nd 15 % in the second group with a rate of anastomotic leak of 11 % and 2 % respectively. Among the second group, the morbidity rate was 20 % after D1 ,5 lymphadenectomy versus 10 % after D1 lymphadenectomy. The overall 5-year survival rate was 29 % in the first group versus 38 % in the second group. In this latter group, the overall 5-year survival was 32 % after D1 lympha denectomy and 46 % after D1,5 (p = 0,038). Conclusion: Radical lymphadenectomy without associated splenic or pancreati c resection in good general status patients may provide a better staging of resected gastric cancer without increase of the postoperative mortality. H owever, the influence of radical lymphadenectomy on long-term survival rema ins to be proven. (C) 2000 Editions scientifiques et medicales Elsevier SAS .