Extended Lymph-Node Dissection for Gastric Cancer

作者：Johannes J. Bonenkamp, J. Hermans, Mitsuru Sasako, Kees Welvaart, Ilfet Songun, Sybren Meyer, John Th. M. Plukker, P. van Elk, Huug Obertop, Dirk J. Gouma, J. Jan B. van Lanschot, C. W. Taat, Peter W. de Graaf, M.F. von Meyenfeldt, Hugo W. Tilanus, C.J.H. van de Velde · 发表于：New England Journal of Medicine · 年份：1999 · DOI：10.1056/nejm199903253401202 · 被引用次数：1600 · 研究领域：Gastric Cancer Management and Outcomes、Esophageal Cancer Research and Treatment、Helicobacter pylori-related gastroenterology studies

BACKGROUND: Curative resection is the treatment of choice for gastric cancer, but it is unclear whether this operation should include an extended (D2) lymph-node dissection, as recommended by the Japanese medical community, or a limited (D1) dissection. We conducted a randomized trial in 80 Dutch hospitals in which we compared D1 with D2 lymph-node dissection for gastric cancer in terms of morbidity, postoperative mortality, long-term survival, and cumulative risk of relapse after surgery. METHODS: Between August 1989 and July 1993, a total of 996 patients entered the study. Of these patients, 711 (380 in the D1 group and 331 in the D2 group) underwent the randomly assigned treatment with curative intent, and 285 received palliative treatment. The procedures for quality control included instruction and supervision in the operating room and monitoring of the pathological results. RESULTS: Patients in the D2 group had a significantly higher rate of complications than did those in the D1 group (43 percent vs. 25 percent, P<0.001), more postoperative deaths (10 percent vs. 4 percent, P= 0.004), and longer hospital stays (median, 16 vs. 14 days; P<0.001). Five-year survival rates were similar in the two groups: 45 percent for the D1 group and 47 percent for the D2 group (95 percent confidence interval for the difference, -9.6 percent to +5.6 percent). The patients who had R0 resections (i.e., who had no microscopical evidence of remaining disease), excluding those who died postope...