05. A randomized controlled study of D2 and D2+ radical surgery for advanced distal gastric cancer

Objective: To compare the safety and efficacy of extended lymph node dissection (D2+) and standard D2 lymph node issection in the treatment of advanced distal gastric cancer.
Methods: From November 2010 to December 2011, 47 cases of distal gastric cancer were included and randomly assigned to D2 surgery group and D2+ surgery group. Reference to the Japanese 3th edition of gastric cancer treatment guideline, the standard D2 radical resection of distal gastric cancer included dissection of No.1, No.3, No.4sb, No.4d, No.5, No.6, No.7 in the first station and No.8a, No.9, No.11p, No.12a in the second station. D2+ radical resection meant an additional dissection of 8p, 12b, 13, 14v lymph nodes on the basis of D2 surgery.
Results: All 47 cases received R0 resection. The average operative time of D2 surgery group and D2+ surgery group was (137±38) minutes and (164±29) minutes, and the difference was statistically significant (P=0.009). However, the intraoperative blood loss, incidence of postoperative complications and hospital stay showed no significant difference (P>0.05). In the D2+ surgery group, the positive rate of extended resected lymph nodes 8p, 12b, 13 and 14v was 0, 8.3%, 8.3% and 12.5%, of which the positive rate of No.13 lymph nodes was related to the involvement of the duodenum.
Discussions: For advanced distal gastric cancer, especially involving the pyloric nanal or duodenum, we considered the D2+ radical resection (D2+8p, 12b, 13, 14 v) was feasible. The procedure was reliability and safety, and did not increase the surgical complications comparing with D2 radical resection. D2+ radical resection could remove more lymph nodes and may reduce the risk of residuing positive lymph nodes. However, D2+ radical resection can improve the prognosis of gastric cancer remains to be elucidated.