Comparison of D2 versus D1 gastrectomy in Kashmiri patients in a tertiary care cancer centre
DOI:
https://doi.org/10.18203/2349-2902.isj20220363Keywords:
Gastric cancer, Kashmir, D1 and D2 gastrectomy, SurvivalAbstract
Background: The aim of this study was to compare the clinical outcomes, survival, morbidity and mortality of D1 and D2 gastrectomy in Kashmiri population in a high-volume tertiary care centre.
Methods: Data were collected retrospectively from the prospective database maintained by Department of Surgical Gastroenterology at SKIMS, Kashmir India. We did direct comparison of D1 and D2 gastrectomy in gastric cancer patients who underwent surgery between January 2016 to December 2021 and fulfilled the eligibility criteria. A total of 98 patients were included in the study of which 46 underwent a D1 gastrectomy and 52 underwent a D2 gastrectomy.
Results: Male-female ratio was 3:1 in both groups with a mean age of 61 years. There was no significant difference in terms of age or gender between D1 and D2 groups (p>0.05). The mean number of harvested lymph nodes (LN) was (7±1.9) in the D1 group compared to (27.6±10.1) the D2 group (p=0.001). Average hospital stay was comparable in both groups. The median survival was 26 months for the D2 and 19 months for the D1 group (p≤0.01). The survival in the D2 group was significantly higher than in the D1 group. There was no difference in postoperative complications between two groups in our study.
Conclusions: our study indicates that D2 gastrectomy should be the standard of treatment for advanced stage II /III disease as it improves the survival outcome in these patients without affecting overall hospital stay, morbidity and mortality.
References
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.
Dikshit RP, Mathur G, Mhatre S, Yeole BB. Epidemiological review of gastric cancer in India. Indian J Med Paediatr Oncol. 2011;32:3-11.
Sharma A, Radhakrishnan V. Gastric cancer in India. Indian J Med Paediatr Oncol. 2011;32:12.
Ayub SG, Ayub T, Khan SN. Epidemiological distribution and incidence of different cancers in Kashmir valley–2002-2006. Asian Pac J Cancer Prev. 2011;12(07):1867-72.
Khan NA, Ahmad SA, Dar NA, Masoodi SR, Lone MM. Changing Pattern of Common Cancers in the Last Five Years in Kashmir, India: A Retrospective Observational Study. Indian J Med Paediatric Oncol. 2021;42:5.
Stolte M. The new Vienna classification of epithelial neoplasia of the gastrointestinal tract: advantages and disadvantages. Virchows Arch. 2003442(2):99-106.
Maehara YOH, Okuyama T, Moriguchi S, Tsujitani S, Korenaga D, Sugimachi K. Predictors of lymph node metastasis in early gastric cancer. Br J Cancer. 1992;79(3):245-7.
Coburn N. Lymph nodes and gastric cancer. J Surg Oncol. 2009;99:199-206.
Memon MA, Subramanya MS, Khan S, Hossain MB, Osland E, Memon B. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Ann Surg. 2011;253:900-11.
Cuschieri AWS, Fielding J, Bancewicz J, Craven J, Joypaul V, Sydes M. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Br J Cancer. 1999;79(9–10):1522-30.
Hartgrink HH vVC, Putter H, Bonenkamp JJ, Klein Kranenbarg E, Songun I, Welvaart K, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol. 2004;22(11):2069-77.
Songun I, Putter H, Kranenbarg EM-K, Sasako M, Van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11(5):439-49.
Degiuli M, Sasako M, Ponti A, Vendrame A, Tomatis M, Mazza C et al. Randomized clinical trial comparing survival after D1 or D2 gastrectomy for gastric cancer. Br J Surg. 2014;101(2):23-3.
Ajani JA, D'Amico TA, Almhanna K. Gastric Cancer, Version 3. 2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2016;14:1286-312.
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20(1):1-19.
Sano T, Sasako M, Mizusawa J, Yamamoto S, Katai H, Yoshikawa T et al. Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma. Ann Surg. 2017;265(2):277-83.
Washington K. 7th edition of the AJCC Cancer staging manual: stomach. Ann Surg Oncol. 2010;17(12):3077-9.
Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101-12.
Clavien PA, Barkun J, de Oliveira ML,Vauthey JN,Dindo D, Bassi C et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187-96.
Biondi A, Persiani R, Cananzi F. R0 resection in the treatment of gastric cancer: room for improvement. World J Gastroenterol. 2010;16(27):3358-70.
Kim YI. Is retrieval of at least 15 lymph nodes sufficient recommendation in early gastric cancer? Ann Surg Treat Res. 2014;87(4):180-4.
Zheng G, Feng F, Guo M. Harvest of at Least 23 Lymph Nodes is Indispensable for Stage N3 Gastric Cancer Patients. Ann Surg Oncol. 2016;9.
Bauer KSM, Porzsolt F, Henne-Bruns D. Comparison of international guidelines on the accompanying therapy for advanced gastric cancer: reasons for the differences. J Gastric Cancer. 2015;15(1):10-8.
Degiuli MMG, Leo AD, D’Ugo D, Galasso E, Marrelli D, Petrioli R et al. Gastric cancer: current status of lymph node dissection. World J Gastroenterol. 2016;22(10):2875-93.
Shrikhande SV, Barreto SG,Talole SD, Vinchurkar K, Annaiah S, Suradkar K, et al. D2 lymphadenectomy is not only safe but necessary in the era of neoadjuvant chemotherapy. World J Surg Oncol. 2013;2:11-31.
Shrikhande SV, Shukla PJ, Qureshi S, Siddachari R, Upasani V, Ramadwar M et al. D2 lymphadenectomy for gastric cancer in Tata Memorial Hospital: Indian data can now be incorporated in future international trials. Dig Surg. 2006;23:192-7.
Zeng WJ, Hu WQ, Wang LW, Yan SG, Li JD, Zhao HL et al. Long term follow up and retrospective study on 533 gastric cancer cases. BMC Surg. 2014;14:29.
Okines A, Verheij M, Allum W, Cunningham D, Cervantes A ESMO Guidelines Working Group. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21:v50-4.
Jiang L, Yang KH, Chen Y, Guan QL, Zhao P, Tian JH et al. Systematic review and meta-analysis of the effectiveness and safety of extended lymphadenectomy in patients with resectable gastric cancer. Br J Surg. 2014;101:595-604.
Bonenkamp JJ, Hermans J, Sasako M, Van de Velde CJ, Welvaart K, Songun I et al. Dutch Gastric Cancer Group. Extended lymphnode dissection for gastric cancer. N Engl J Med. 1999;340:908-14.
Birkmeyer JD, Siewers AE, Finlayson EV. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128-37.
Degiuli M, Sasako M, Ponti A, Italian Gastric Cancer Study Group: Br J Surg 2010;97:643–649
Safaee A, Moghimi-Dehkordi B, Fatemi SR. Clinicopathological Features of Gastric Cancer: A Study Based on Cancer Registry Data. IJCP. 2009;2:67-70.
Sasagawa T, Solano H, Mena F. Gastric cancer in Costa Rica. Gastrointest Endosc. 1999;50:594-5.
Yao JC, Tseng JF, Worah S. Clinicopathologic behavior of gastric adenocarcinoma in Hispanic patients: analysis of a single institution’s experience over 15 years. J Clin Oncol. 2005;23:3094-103.
Sadjadi A, Malekzadeh R, Derakhshan MH. Cancer occurrence in Ardabil: results of a population-based cancer registry from Iran. Int J Cancer. 2003;107:113-8.
Wu H, Rusiecki JA, Zhu K, Potter J, Devesa SS. Stomach carcinoma incidence patterns in the United States by histologic type and anatomic site. Cancer Epidemiol Biomarkers Prev. 2009;18:1945-52.
Malik GM, Mubarik M, Kadla SA, Durrani HA. Gastric cancer profile in Kashmiri population with special dietary habits. Diagn Ther Endosc. 2000;6:83-6.
Bhandare MS, Kumar NAN, Batra S, Chaudhari V, Shrikhande SV. Radical gastrectomy for gastric cancer at Tata Memorial Hospital. Indian J Cancer. 2017;54(4):605-8.
Nandi A, Biswas PK, Kar M, Sinha SK. Clinicopathological profile of gastric cancer in a tertiary care hospital in Eastern India: a prospective 2 year study. Clin Cancer Investig J. 2014;3:14-20
Zheng L, Wu C, Xi P, Zhu M, Zhang L, Chen S et al. The survival and the long-term trends of patients with gastric cancer in Shanghai, China. BMC Cancer. 2014;14:300.
Hundahl SA, Phillips JL, Menck HR. The National Cancer Data Base Report on poor survival of U.S. gastric carcinoma patients treated with gastrectomy: fifth Edition American Joint Committee on Cancer staging, proximal disease, and the “different disease” hypothesis. Cancer. 2000;88:921-32.
Mickevicius A, Ignatavicius P, Markelis R, Parseliunas A, Butkute D, Kiudelis M et al. Trends and results in treatment of gastric cancer over last two decades at single East European centre: a cohort study. BMC Surg. 2014;14:98.