Does the surgical technique and the academic level of the hospital have impact on survival in gastric cancer? a retrospective study

Süleyman Orman, Haydar Yalman, Mehmet Rafet Yiğitbaşı


Background: Cure may only be achieved through surgical resection in gastric cancer. In this paper, we retrospectively analyzed the effects of D1 and D2 dissection and type of the performed operation as well as type of the hospital on survival.

Methods: Total of 125 patients, who had been operated for gastric cancer in two separate hospitals between January 2003 and June 2007 were retrospectively studied. The patients who met the criteria of the study were divided into four groups according to the operation type. Difference between the survival rates, median survival of the patients with respect to the type of the operation and hospitals were analyzed.

Results: Of the patients, 66 had total gastrectomy + D1 lymph node dissection, 39 had distal subtotal gastrectomy + D1 lymph node dissection, 7 had total gastrectomy + D2 lymph node dissection, and 13 had distal subtotal gastrectomy + D2 lymph node dissection. Analysis of 3-year survival of the patients demonstrated no statistically significant difference between the groups with respect to the survival rates, median survival of the patients and the hospitals (p<0.05).

Conclusions: This study indicated that there was no significant difference between survivals with regard to the institution where the operation had been performed, the operation type and the extent of the dissection.


Gastric cancer, Gastrectomy, Lymph node dissection

Full Text:



Coleman MP, Damiecki P, Arslan A, Renard H. Trends in Cancer Incidence and Mortality. In: IARC Scientific Publications. 1993.

Yilmaz HH, Yazihan N, Tunca D, Sevinc A, Olcayto EO, Ozgul N, et al. Cancer trends and incidence and mortality patterns in Turkey. Jpn J Clin Oncol. 2011;41:10-6.

American Joint Committee on Cancer Stomach. In: Green F, Page P, Fleming I, et al. (eds) AJCC Cancer Staging Manual. 6th edition. New York, NY: Springer Verlag. 2002:99-103.

Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, et al. D2 lymphadenectomy alone or with paraaortic nodal dissection for gastric cancer. N Engl J Med. 2008;31:453-62.

Sano T, Sasako M, Yamamoto S, Nashimoto A, Kurita A, Hiratsuka M, et al. Gastric Cancer Surgery: Morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy-Japan Clin Oncol group study. J Clin Oncol. 2004;22,2767-3.

NHS Executive: Guidance on Commissioning Cancer Services: Improving outcomes in upper gastro-intestinal cancers 2001. Available at

Kajitani T: Japanese Research Society for the Study of Gastric Cancer. The general rules for gastric cancer study in surgery and pathology. Jpn J Surg. 1981;11:127-45.

Sano T, Kobari O, Muto T. Lymph node metastasis from early gastric cancer: endoscopic resection of tumour. Br J Surg. 1992;79:241-4.

Roder JD, Böttcher K, Siewert JR, Busch R, Hermanek P, Meyer HJ. Prognostic factors in gastric carcinoma. Cancer. 1993;72:2089-97.

Wanebo HJ, Kennedy BJ, Chmiel J, Steele G Jr, Winchester D, Osteen R. Cancer of stomach. A patient care study by the American College of Surgeons. Ann Surg 1993;218:583-92.

Kitano S, Shiraishi N. Current status of laparascopic gastrectomy for cancer in Japan. Surg Endosc. 2004;18:182-5.

Al-Refaie WB, Abdalla EK, Ahmed SA, Mansfield PF. Gastric Cancer. In: Feig Barry W, Berger David H, Fuhrman George M, et al (eds). The M. D. Anderson Surgical Oncology Handbook. 4th Ed. Texas: Lippincott Williams and Wilkins. 2006;205-36.

Dent DM, Werner ID, Novis B, Cheverton P, Brice P. Prospective randomized trial of combined oncological therapy for gastric carcinoma. Cancer 1979;44: 85-91.

Bonenkemp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995;345:745-8.

Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, et al. Patient survival after D1 and D2 resections for gastric cancer. Long term results of the MRC randomised surgical trial. Surgical Cooperative Group. Br J Cancer. 1999;79:1522-30.

Fink U, Schuhmacher C, Stein HJ, Busch R, Feussner H, Dittler HJ, et al. Preoperative chemotherapy for stage III-IV gastric carcinoma: feasibility, response and outcome after complete resection. Br J Surg. 1995;82:1248-52.

Wilke H, Fink U. Multimodal therapy for adenocarcinoma of the esophagus and esophagogastric junction. N Engl J Med. 1996;335:509-10.

Hermans J, Bonenkamp JJ, Boon MC, Bunt AM, Ohyama S, Sasako M, et al. Adjuvant chemoterapy after curative resection for gastric cancer: meta-analysis of randomized trials. J Clin Oncol. 1993;11:1441-7.

Nakajima T. Review of adjuvant chemotherapy for gastric cancer. World J Surg. 1995;11:1441-7.