Value of Hepatoduodenal Ligament and Retropancreatic Lymph Node Dissection (D2+alpha) in Gastric Cancer Surgery

ABSTRACT

PURPOSE: Obstructive jaundice is a rare presentation in patients undergoing curative gastrectomy for gastric cancer. It is most commonly caused by lymphatic metastasis in the lymph nodes around the head of the pancreas and hepatoduodenal ligament, especially when advanced gastric cancer is located in the pyloric antrum. This incidence suggests that extended and systemic lymph node dissection maybe reduce the risk of the development of obstructive jaundice after gastrectomy. In this study we tried to evaluate the effectiveness of D2+alpha lymph node dissection in preventing obstructive jaundice during gastric cancer treatment. METHODS: Twenty-four patients who underwent D2+alpha lymph node dissection in the course of gastric cancer treatment at Asan Medical Center between June 1995 and May 1997 were retrospectively analyzed on the basis of medical records. The mean age of the patients was 54 years, and the male to female ratio was 3.9 1. RESULTS: Four patients (16.6%) developed complications (Ed-perhaps you wish to insert here, "other than tumor recurrence") but these were not serious. Tumor recurrence developed in 11 patients, and obstructive jaundice was revealed in one (4.1%) of these. All recurrent patients were more than stage III (Ed-confirming that this means stage 4 or more) with the most common recurrence site being the peritoneum (72.7%). The mean duration from operation to recurrence and from recurrence to death was 13.9 months and 7.9 months, respectively. CONCLUSION: It is possible (Ed- or slightly stronger, "It is apparent") that D2+alpha dissection provides no benefit in preventing obstructive jaundice, compared with other reports (Ed- i.e. 'in comparison with other studies'. I wonder if you don't intend, "compared with the efficacy of other treatment modalities"), and that the most common site of recurrence was the peritoneum.