Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2016; 22(14): 3813-3820
Published online Apr 14, 2016. doi: 10.3748/wjg.v22.i14.3813
Vascularizing lymph node dissection for advanced gastric cancer: A single-institution experience
Fang-Hai Han, Sheng-Ning Zhou, Hong-Ming Li, Yu-Long He, Wen-Hua Zhan
Fang-Hai Han, Sheng-Ning Zhou, Hong-Ming Li, Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
Yu-Long He, Wen-Hua Zhan, Department of Gastrointestinal-Pancreatic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
Author contributions: Han FH and Zhou SN contributed equally to this work; Han FH and Zhou SN designed the research; Zhan WH, He YL and Han FH performed the research; Li HM contributed new reagents or analytic tools; Zhou SN analyzed the data; Han FH and Zhou SN wrote the paper.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Sun Yat-sen Memorial Hospital.
Informed consent statement: All study participants, or their legal guardian, provided verbal informed consent.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Wen-Hua Zhan, PhD, Department of Gastrointestinal-Pancreatic Surgery, the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Erlu, Guangzhou 510000, Guangdong Province, China. wh_zhan@126.com
Telephone: +86-20-28823388
Received: October 11, 2015
Peer-review started: October 12, 2015
First decision: December 11, 2015
Revised: December 17, 2015
Accepted: January 17, 2016
Article in press: January 18, 2016
Published online: April 14, 2016
Processing time: 170 Days and 14.9 Hours
Abstract

AIM: To compare the short- and long-term outcomes of vascularizing lymph node dissection (VLND) and non-vascularizing lymph node dissection (NVLND) from a single institution.

METHODS: Data of 315 patients with advanced gastric cancer who underwent standard D2 lymphadenectomy with curative intent was collected between January 1994 and December 2006. One hundred and fifty-two patients received VLND while 163 patients received NVLND. Short- and long-term clinical outcomes were compared between the two groups.

RESULTS: The median followed-up time was 82 mo. The rate of postoperative complications in the VLND group was 13.2%, while that in the NVLND group was 11.7% (P = 0.686). The overall 5-year survival rate was 64% in the VLND group and 59% in the NVLND group (P = 0.047). When subgroup analyses were performed according to Bormann type, type of differentiation and lymph node status, survival benefit was demonstrated in patients with Bormann type III or IV (59% vs 50%, P = 0.032), undifferentiated type (63% vs 49%, P = 0.021) or presence of lymph node metastasis (53% vs 38%, P = 0.010) in the VLND group.

CONCLUSION: D2 VLND in advanced gastric cancer treatment allows survival benefit with acceptable morbidity and mortality. VLND for patients with potentially curable advanced gastric cancer is feasible and safe when performed by a well-trained surgical team.

Keywords: Gastric cancer; Vascularizing lymph node dissection; Non-vascularizing lymph node dissection; Clinical outcome

Core tip: This study investigates the short- and long-term outcomes of vascularizing lymph node dissection (VLND) and non-vascularizing lymph node dissection (NVLND) from a single institution. The overall 5-year survival rate was 64% in the VLND group and 59% in the NVLND group (P = 0.047). We draw a conclusion that VLND with D2 lymphadenectomy has overall survival benefit for patients with advanced gastric cancer without significant operative complications and mortality if performed by a well-trained and experienced surgical team. If undifferentiated adenocarcinoma is confirmed by endoscopic biopsy preoperatively or macroscopically enlarged regional lymph nodes are found intraoperatively in advanced gastric cancer, VLND with D2 lymphadenectomy may be a considerable alternative.