[Stomach carcinoma. Optimizing therapy by extended lymph node dissection].

Background: The prognosis for surgically treated gastric cancer patients remains poor in most Western countries compared with reports of Japanese investigators over the last three decades. The aim of the study was to prove whether D2, D3 lymphadenectomy is able to improve long-term survival in a Western gastric cancer patients collective as well.

Methods: A radical surgical procedure using D2, D3 lymphadenectomy on principle as defined by the Japanese Research Society for Gastric Cancer was done prospectively since January 1984. Out of 626 patients with gastric cancer, 433 were surgically treated for potential cure between January 1st, 1984 and December 31st, 1996. Postoperative complications and long-term survival were evaluated.

Results: For curatively operated patients five- and ten-year tumor specific survival rates were 57.7% and 44.3%, the median survival time was 96 months. Postoperative hospital mortality was 4.8% for R0 resected patients and 10.4% for palliative procedures.

Conclusion: Radical D2, D3 lymphadenectomy yielded survival rates similar to those in Japanese investigations without negative effect on low postoperative mortality. These results reaffirm the value of radical lymph node dissection with wide resection margins.