D2 lymphadenectomy plus para-aortic nodal dissection: no added benefit for gastric cancer

D2 lymphadenectomy plus para-aortic nodal dissection was not superior to D2 lymphadenectomy alone in improving the survival rate in curable gastric cancer, according to recent data.

In a randomized, controlled trial, researchers from the Japan Clinical Oncology Group randomly assigned patients with stage T2b, T3 or T4 cancer (n=523) to D2 lymphadenectomy (n=263) or D2 lymphadenectomy plus para-aortic nodal dissection (n=260) during gastrectomy.

Surgery-related complications occurred in both groups: 20.9% for D2 lymphadenectomy alone and 28.1% for D2 lymphadenectomy plus para-aortic nodal dissection. Frequency of anastomotic leakage, pancreatic fistula, abdominal abscess, pneumonia or death from any cause within 30 days following surgery did not differ between the two groups.

Five-year overall survival rates were also similar between the two groups: 69.2% for D2 lymphadenectomy alone and 70.3% for D2 lymphadenectomy plus para-aortic nodal dissection. The hazard ratio for death was 1.03 (P=.85), according to the abstract. Differences in recurrence-free survival were not significant (HR=1.08; P=.56).

In the D2 lymphadenectomy plus para-aortic nodal dissection group, median surgery time was 63 minutes longer and median blood loss was 230 ml greater, according to the researchers.

N Engl J Med. 2008;359:453-462.