Geen betere prognose door uitgebreide lymfklierdissectie bij maagresectie wegens maagkanker; een prospectief, gerandomiseerd Nederlands onderzoek

To compare the standard lymph node dissection (D1) with the extensive lymph node dissection (D2) in the treatment of gastric cancer.

Design

Prospective, randomized.

Methods

In the period from 1 August 1989 to 30 June 1993, 1078 gastric cancer patients younger than 85 years were reported by 80 Dutch hospitals to the study centre and randomized there. 711 Of them could be subjected to a curative resection: 380 to a D1 and 331 to a D2 dissection. Follow-up examinations were carried out every 3 months during the first year after the operation, and every 6 months afterward. Follow-up data were provided by the surgeon in attendance on separate forms. The reference date was 1 December 1997. Result parameters were 5-year survival and tumour recurrence.

Results

The patients subjected to curative operation were 215 males and 165 females with a median age of 67 years in the D1 group: and 187 males and 144 females with a median age of 65 years in the D2 group. Hospital morbidity (D1 group: 25; D2 group: 41), hospital mortality (D1 group: 4; D2 group: 10) and median duration of hospital stay (D1 group: 14 days; D2 group: 16 days) were significantly worse in the D2 group. The 5-year survival was 45 in the D1 group and 47 in the D2 group (95 confidence interval for the difference (95 CI): -9.6-5.6). The proportions of 5-year recurrence and microscopically radical resection were not significantly different, either: 43 for D1 and 37 for D2 dissection (95 CI: -2,4-14,4).

Conclusion

The significantly higher morbidity after D2 lymph node dissection is not compensated by better survival. Extensive lymph node dissection should not be used as a standard treatment in our population.