EXTENDED LYMPH-NODE DISSECTION FOR GASTRIC-CANCER - RESULTS OF A PROSPECTIVE, MULTICENTER ANALYSIS OF MORBIDITY AND MORTALITY IN 118 CONSECUTIVE CASES

This study reports interim data on post-operative morbidity, hospital mortality and duration of hospital stay of Italian patients undergoing extended lymph-node dissection combined with a pancreas-preserving te chnique for gastric cancer, Of the 218 patients admitted to one of eig ht general and/or university hospitals in North Italy, 118 were enroll ed in the trial, Eligible patients presented with proven primary adeno carcinoma of the stomach without clinical evidence of distant, periton eal and/or liver metastasis, or metastasis in para-aortic and retropan creatic nodes at intraoperative biopsy, Patients underwent the extende d procedure as described by the Japanese Research Society for the Stud y of Gastric Cancer, following the Maruyama pancreas-preserving techni que, A strict quality control system,vas used to ensure the performanc e of a standard surgical treatment, A surgeon of the reference centre (M.D.), who stayed at the National Cancer Center Hospital in Tokyo to learn the D2 technique from a specialist Japanese surgeon, became the trial supervisor and assisted each surgeon in all the Italian particip ating centres, The patients were staged according both to the TNM syst em and to the General Rules for the Gastric Cancer Study in Surgery an d Pathology, Post-operative surgical complications developed in 21 pat ients (17.8%), The non-surgical complication rate was 2.5%, Reoperatio n was necessary in six patients (5%), all of whom survived, The 30-day mortality rate for the eligible group was 2.5%, The overall hospital mortality was the same, Total gastrectomy was associated with a slight ly higher operative mortality (4.5% vs 1.3%), Only one patient died fr om an anastomotic leak, The rate of leakages was higher after total th an after distal gastrectomy (15.9 vs 5.4%); the association of splenec tomy and pancreatectomy worsened the morbidity rate, D2 lymphadenectom y with pancreas-preserving technique, when performed at experienced ce ntres, seems a feasible and safe technique for the radical treatment o f gastric cancer in selected Western patients.