Prospective comparison of DI vs modified D2 gastrectomy for carcinoma

To compare the outcomes after D1 gastrectomy with those after modified D2 gastrectomy (preserving pancreas and spleen) per-formed by specialist surgeons for gastric cancer in a large UK NHS Trust, In all, 1 18 consecutive patients with gastric adenocarcinoma were referred by postcode, to undergo either a D1 gastrectomy (North Gwent (RJ), n = 36, median age 76 years, 21 m) or a modified D2 gastrectomy (South Gwent (WL), n = 82, 70 years, 57 m). Operative mortality in the two groups of patients was similar (D1 8.3% vs D2 7.3%, chi(2) 0.286, DF I, P=0.593). Overall cumulative survival at 5 years was 32% after D1 gastrectonny compared to 59% after D2 gastrectomy (chi(2) 4.25, DF I, P=0.0392). In patients with stage III cancers, survival was 8% after D1, compared with 33% after D2 gastrectomy (chi(2) 6.43, DF I, P = 0.0112). In a multivariate analysis, T stage (hazard ratio 2.339, 95% Cl 1.683-2.995, P = 0.01), N stage (hazard ratio 4.026, 95% Cl 3.536-4.516, P = 0.0001) and the extent of lymphadenectomy (hazard ratio 0.258, 95% Cl-0.426-0.942, P = 0.0001) were independently associated with durations of survival. In conclusion, modified D2 gastrectomy can improve survival fourfold for patients with stage III gastric cancer, without significantly increasing morbidity and mortality when compared with a D1 gastrectomy. (C) 2004 Cancer Research UK.