Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2022; 28(3): 381-398
Published online Jan 21, 2022. doi: 10.3748/wjg.v28.i3.381
Postoperative mortality and morbidity after D2 lymphadenectomy for gastric cancer: A retrospective cohort study
Giuseppe Brisinda, Maria Michela Chiarello, Anna Crocco, Neill James Adams, Pietro Fransvea, Serafino Vanella
Giuseppe Brisinda, Abdominal Surgery, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
Giuseppe Brisinda, Department of Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, Rome 00168, Italy
Maria Michela Chiarello, General Surgery Operative Unit, Azienda Sanitaria Provinciale di Crotone, Ospedale San Giovanni di Dio, Crotone 88900, Italy
Anna Crocco, Endocrine Surgery Operative Unit, Istituto Nazionale Tumori, IRCCS Fondazione Pascale, Napoli 80100, Italy
Neill James Adams, Health Sciences, Clinical Microbiology Unit, Magna Grecia University, Catanzaro 88100, Italy
Pietro Fransvea, Department of Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
Serafino Vanella, Department of General and Oncological Surgery, Azienda Ospedaliera San Giuseppe Moscati, Avellino 83100, Italy
Author contributions: Brisinda G and Chiarello MM designed the research; Brisinda G, Chiarello MM and Vanella S performed the research; Crocco A and Vanella S analyzed the data; Brisinda G, Chiarello MM, Vanella S, Adams NJ and Fransvea P wrote the paper.
Institutional review board statement: Not necessary for this type of publication.
Clinical trial registration statement: Research Registry ID: researchregistry6939,
Informed consent statement: Informed consent was waived due to the retrospective nature of this study.
Conflict-of-interest statement: No conflict of interest.
Data sharing statement: All the data used are present in the text. No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
Corresponding author: Giuseppe Brisinda, MD, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo Agostino Gemelli 8, Rome 00168, Italy.
Received: October 4, 2021
Peer-review started: October 4, 2021
First decision: November 7, 2021
Revised: November 9, 2021
Accepted: January 11, 2022
Article in press: January 11, 2022
Published online: January 21, 2022
Research background

Gastric cancer surgery is a complex procedure. Lymphadenectomy is essential for the surgical treatment of gastric cancer. Mortality and postoperative morbidity after gastric cancer surgery are not negligible.

Research motivation

We investigated in a population of 186 patients with stomach cancer undergoing surgery with D2 lymphadenectomy which factors were related to postoperative mortality and morbidity.

Research objectives

To evaluate the factors determining mortality and morbidity in a population of patients undergoing R0 resection and D2 lymphadenectomy for gastric cancer.

Research methods

For each patient we calculated the Kattan’s score. The following prognostic variables were assembled for use in validating the nomogram: age, sex, primary site (distal one-third, middle one-third, proximal one-third, and gastroesophageal junction), Lauren histotype (diffuse, intestinal, mixed), number of positive lymph nodes resected, number of negative lymph nodes resected, and depth of invasion as defined by the standard nomenclature.

Research results

Perioperative mortality rate was 3.8% (7 patients); a higher mortality rate was observed in patients aged > 65 years (P = 0.002) and in N+ patients (P = 0.04). Following univariate analysis, mortality was related to a Kattan’s score ≥ 100 points (P = 0.04) and the presence of advanced gastric cancer (P = 0.03). Morbidity rate was 21.0% (40 patients). Surgical complications were observed in 17 patients (9.1%). A higher incidence of morbidity was observed in patients where more than 35 lymph nodes were harvested (P = 0.0005).

Research conclusions

Mortality and morbidity rate are higher in N+ and advanced gastric cancer patients. The removal of more than 35 lymph nodes does not lead to an increase in mortality.

Research perspectives

An extended lymph nodes dissection in patients undergoing surgical treatment for gastric cancer is a safe procedure.