Is d2 lymphadenectomy in gastrectomy safe with regard to the skill of the operator?

Citation
Y. Moriwaki et al., Is d2 lymphadenectomy in gastrectomy safe with regard to the skill of the operator?, DIGEST SURG, 18(2), 2001, pp. 111-117
Citations number
43
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Surgery
Journal title
DIGESTIVE SURGERY
ISSN journal
0253-4886 → ACNP
Volume
18
Issue
2
Year of publication
2001
Pages
111 - 117
Database
ISI
SICI code
0253-4886(2001)18:2<111:IDLIGS>2.0.ZU;2-#
Abstract
Background/Aims: D2 gastrectomy has been regarded as an inconvenient proced ure with high morbidity and no survival benefit in the West. Recent western studies, however, especially from specialist centers, have shown a surviva l benefit and the safety of D2 gastrectomy. The aim of this study is to cla rify the safety of D2 gastrectomy (defined by the Japanese Research Society for the Study of Gastric Cancer), even if carried out by a junior surgeon, and to show that it is not a particularly difficult or special procedure. Methods: Patients who underwent a typical distal gastrectomy (DG) with D2 r esection (n = 344) and total gastrectomy (TG) with D2 resection (n 111) wer e analyzed. The subjects were divided into 3 groups according to the postgr aduate year of the operator (group I = the surgeon's postgraduate experienc e was less than 5 years; group II = surgeons with more than 5 years and les s than 10 years postgraduate experience; group III = surgeons with more tha n 10 years postgraduate experience). The rate of postoperative complication s and the 5-year survival rate were compared among the 3 groups. Results: T he overall operative mortality rate, hospital death rate and the overall ra te of postoperative complications were 1.2, 2.0 and 10.2% in DG patients, a nd 14.4, 0 and 1.8% in TG patients, respectively. There was no significant difference in the operative blood loss, the rate of operative mortality, ho spital death rate and postoperative complications among the 3 groups. There was no significant difference in the 5-year survival rate among the 3 grou ps in each stage. Conclusion: The postoperative mortality rate, morbidity r ate and 5-year survival rate after a typical D2 gastrectomy were independen t of the experience of the operator. It is considered to be a safe and usef ul procedure in view of the rate of postoperative complications and the lon gterm survival rate, even if performed by a junior trainee under the superv ision of experienced surgeons in a nonspecialized hospital. Copyright (C) S . Karger AG, Basel.