Extent of lymphadenectomy has no impact on postoperative complications after gastric cancer surgery in Sweden

Chih Han Kung, Huan Song, Weimin Ye, Magnus Nilsson, Jan Johansson, Ioannis Rouvelas, Tomoyuki Irino, Lars Lundell, Jon A. Tsai, Mats Lindblad

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: Curative gastric cancer surgery entails removal of the primary tumor with adequate margins including regional lymph nodes. European randomized controlled trials with recruitment in the 1990’s reported increased morbidity and mortality for D2 compared to D1. Here, we examined the extent of lymphadenectomy during gastric cancer surgery and the associated risk for postoperative complications and mortality using the strengths of a population-based study. Methods: A prospective nationwide study conducted within the National Register of Esophageal and Gastric Cancer. All patients in Sweden from 2006 to 2013 who underwent gastric cancer resections with curative intent were included. Patients were categorized into D0, D1, or D1+/D2, and analyzed regarding postoperative morbidity and mortality using multivariable logistic regression. Results: In total, 349 (31.7%) patients had a D0, 494 (44.9%) D1, and 258 (23.4%) D1+/D2 lymphadenectomy. The 30-d postoperative complication rates were 25.5%, 25.1% and 32.2% (D0, D1 and D1+/D2, respectively), and 90-d mortality rates were 8.3%, 4.3% and 5.8%. After adjustment for confounders, in multivariable analysis, there were no significant differences in risk for postoperative complications between the lymphadenectomy groups. For 90-d mortality, there was a lower risk for D1 vs. D0. Conclusions: The majority of gastric cancer resections in Sweden have included only a limited lymphadenectomy (D0 and D1). More extensive lymphadenectomy (D1+/D2) seemed to have no impact on postoperative morbidity or mortality.

Original languageEnglish
Pages (from-to)313-322
Number of pages10
JournalChinese Journal of Cancer Research
Volume29
Issue number4
DOIs
Publication statusPublished - 2017 Aug 1
Externally publishedYes

Fingerprint

Lymph Node Excision
Sweden
Stomach Neoplasms
Mortality
Morbidity
Esophageal Neoplasms
Randomized Controlled Trials
Logistic Models
Lymph Nodes
Prospective Studies
Population
Neoplasms

Keywords

  • Complications
  • Gastric cancer
  • Lymphadenectomy
  • Mortality
  • National database

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Extent of lymphadenectomy has no impact on postoperative complications after gastric cancer surgery in Sweden. / Kung, Chih Han; Song, Huan; Ye, Weimin; Nilsson, Magnus; Johansson, Jan; Rouvelas, Ioannis; Irino, Tomoyuki; Lundell, Lars; Tsai, Jon A.; Lindblad, Mats.

In: Chinese Journal of Cancer Research, Vol. 29, No. 4, 01.08.2017, p. 313-322.

Research output: Contribution to journalArticle

Kung, CH, Song, H, Ye, W, Nilsson, M, Johansson, J, Rouvelas, I, Irino, T, Lundell, L, Tsai, JA & Lindblad, M 2017, 'Extent of lymphadenectomy has no impact on postoperative complications after gastric cancer surgery in Sweden', Chinese Journal of Cancer Research, vol. 29, no. 4, pp. 313-322. https://doi.org/10.21147/j.issn.1000-9604.2017.04.04
Kung, Chih Han ; Song, Huan ; Ye, Weimin ; Nilsson, Magnus ; Johansson, Jan ; Rouvelas, Ioannis ; Irino, Tomoyuki ; Lundell, Lars ; Tsai, Jon A. ; Lindblad, Mats. / Extent of lymphadenectomy has no impact on postoperative complications after gastric cancer surgery in Sweden. In: Chinese Journal of Cancer Research. 2017 ; Vol. 29, No. 4. pp. 313-322.
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abstract = "Objective: Curative gastric cancer surgery entails removal of the primary tumor with adequate margins including regional lymph nodes. European randomized controlled trials with recruitment in the 1990’s reported increased morbidity and mortality for D2 compared to D1. Here, we examined the extent of lymphadenectomy during gastric cancer surgery and the associated risk for postoperative complications and mortality using the strengths of a population-based study. Methods: A prospective nationwide study conducted within the National Register of Esophageal and Gastric Cancer. All patients in Sweden from 2006 to 2013 who underwent gastric cancer resections with curative intent were included. Patients were categorized into D0, D1, or D1+/D2, and analyzed regarding postoperative morbidity and mortality using multivariable logistic regression. Results: In total, 349 (31.7{\%}) patients had a D0, 494 (44.9{\%}) D1, and 258 (23.4{\%}) D1+/D2 lymphadenectomy. The 30-d postoperative complication rates were 25.5{\%}, 25.1{\%} and 32.2{\%} (D0, D1 and D1+/D2, respectively), and 90-d mortality rates were 8.3{\%}, 4.3{\%} and 5.8{\%}. After adjustment for confounders, in multivariable analysis, there were no significant differences in risk for postoperative complications between the lymphadenectomy groups. For 90-d mortality, there was a lower risk for D1 vs. D0. Conclusions: The majority of gastric cancer resections in Sweden have included only a limited lymphadenectomy (D0 and D1). More extensive lymphadenectomy (D1+/D2) seemed to have no impact on postoperative morbidity or mortality.",
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AU - Johansson, Jan

AU - Rouvelas, Ioannis

AU - Irino, Tomoyuki

AU - Lundell, Lars

AU - Tsai, Jon A.

AU - Lindblad, Mats

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AB - Objective: Curative gastric cancer surgery entails removal of the primary tumor with adequate margins including regional lymph nodes. European randomized controlled trials with recruitment in the 1990’s reported increased morbidity and mortality for D2 compared to D1. Here, we examined the extent of lymphadenectomy during gastric cancer surgery and the associated risk for postoperative complications and mortality using the strengths of a population-based study. Methods: A prospective nationwide study conducted within the National Register of Esophageal and Gastric Cancer. All patients in Sweden from 2006 to 2013 who underwent gastric cancer resections with curative intent were included. Patients were categorized into D0, D1, or D1+/D2, and analyzed regarding postoperative morbidity and mortality using multivariable logistic regression. Results: In total, 349 (31.7%) patients had a D0, 494 (44.9%) D1, and 258 (23.4%) D1+/D2 lymphadenectomy. The 30-d postoperative complication rates were 25.5%, 25.1% and 32.2% (D0, D1 and D1+/D2, respectively), and 90-d mortality rates were 8.3%, 4.3% and 5.8%. After adjustment for confounders, in multivariable analysis, there were no significant differences in risk for postoperative complications between the lymphadenectomy groups. For 90-d mortality, there was a lower risk for D1 vs. D0. Conclusions: The majority of gastric cancer resections in Sweden have included only a limited lymphadenectomy (D0 and D1). More extensive lymphadenectomy (D1+/D2) seemed to have no impact on postoperative morbidity or mortality.

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