Surgical and oncological outcomes of D1 versus D2 gastrectomy among elderly patients treated for gastric cancer

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Back , J , Sallinen , V , Kokkola , A & Puolakkainen , P 2022 , ' Surgical and oncological outcomes of D1 versus D2 gastrectomy among elderly patients treated for gastric cancer ' , Scandinavian Journal of Surgery , vol. 111 , no. 2 , 14574969221096193 . https://doi.org/10.1177/14574969221096193

Title: Surgical and oncological outcomes of D1 versus D2 gastrectomy among elderly patients treated for gastric cancer
Author: Back, Johan; Sallinen, Ville; Kokkola, Arto; Puolakkainen, Pauli
Contributor organization: Department of Surgery
Faculty of Medicine
II kirurgian klinikka
HUS Abdominal Center
Clinicum
Pertti Panula / Principal Investigator
Department of Anatomy
University of Helsinki
IV kirurgian klinikka
Teachers' Academy
Pauli Puolakkainen / Principal Investigator
Date: 2022-06
Language: eng
Number of pages: 7
Belongs to series: Scandinavian Journal of Surgery
ISSN: 1457-4969
DOI: https://doi.org/10.1177/14574969221096193
URI: http://hdl.handle.net/10138/345854
Abstract: Introduction: Gastrectomy with D2 lymphadenectomy is considered standard treatment in gastric cancer (GC). Among Western patients, morbidity and mortality seem to increase in D2 relative to D1 lymphadenectomy. As elderly patients with co-morbidities are more prone to possible complications, it is unclear whether they benefit from D2 lymphadenectomy. This study aims to compare the short- and long-term results of D1 and D2 lymphadenectomy in elderly patients undergoing gastrectomy for GC. Methods: All elderly (> 75 years) patients undergoing gastrectomy with curative intent for GC during 2000-2015 were included and grouped according to the level of lymph node dissection into the D1 or D2 group. Short-term surgical outcome included the Comprehensive Complication Index (CCI) and 30-day mortality. Long-term outcomes comprised overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS). Cox regression was used in multivariable analyses. Results: In total, 99 elderly patients were included in the study (51 in D1 group, 48 in D2 group). The median follow-up was 32.5 months. Patients in the D1 group were older and had a higher American Society of Anesthesiologist (ASA) score. Both groups had similar burden of postoperative complications (CCI 20.9 versus 22.6, p = 0.26, respectively) and 90-day mortality (2% for both groups). The OS, DSS, and DFS were similar between groups. Multivariable analysis adjusted for potential confounders detected no difference in the survival between the D1 and D2 groups. Conclusions: Gastrectomy with D2 lymphadenectomy can be performed with low postoperative morbidity and mortality suggesting its use also in the elderly. Long-term outcomes seem similar but need further studies.
Subject: Gastric cancer
gastrectomy
lymph node dissection
elderly
complication
SURGERY
COMPLICATIONS
SPLENECTOMY
IMPACT
AGE
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Rights: cc_by_nc
Usage restriction: openAccess
Self-archived version: publishedVersion


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