In Taiwan, gastric cancer is the fifth most common cancer. Although surgery is the gold standard treatment for these patients, the role of radical lymph node dissection is still debated. Therefore, Prof Chew-Wun Wu (Taipai Veterans General Hospital, Taipei, Taiwan) and colleagues randomly assigned 221 patients to more extensive (D3) or less extensive (D1) surgery and compared 5-year overall survival in the two patient groups.
Patients in the D3 group had more short-term morbidity, more complications and blood loss, longer operation times, and longer hospital stays than those assigned to the D1 group. However, overall 5-year survival was significantly higher in D3 patients compared with those in the D1 group (59.5% vs. 53.6%).
Lead researcher Professor Wu states: "D3 nodal dissection, compared with that of D1, offers a survival benefit for patients with gastric cancer when done by well trained, experienced surgeons".
In an accompanying Reflection and Reaction article, Prof Mitchell Posner and Dr Kevin Roggin (University of Chicago Pritzker School of Medicine, Chicago, IL, USA) comment that "to our knowledge, this is the first study in which one group of experienced surgeons have assessed prospectively the absolute surgical effect of extended lymphadenectomy on survival with advanced gastric cancer". However, they add that: "A single institution trial with a unimodal surgical approach to advanced gastric cancer is not generalisable, and does not take into account the important contribution of adjuvant treatment".
Contact: Prof Chew-Wun Wu. Department of Surgery, Taipai Veterans General Hospital, ShiPai Road, Taipei, Taiwan, 11217 T) 886-2-28757536. cwwu@vghtpe.gov.tw
Contact: Dr Kevin K Roggin, University of Chicago Pritzker School of Medicine, Department of Surgery, 5841 S Maryland Avenue, MC5031, Chicago, IL 60637, USA. T) 1 773-834-4589 kroggin@surgery.bsd.uchicago.edu
The Lancet Oncology