Differential effects of radical D2-lymphadenectomy and splenectomy in surgically treated gastric cancer patients.

BACKGROUND/AIMS: Radical surgery with extended lymph node dissection (D2-LA) is the treatment of choice for gastric cancer patients in Japan. In Western countries results after D2-LA are controversially discussed, as increased D2-LA related complications are reported. The aim of this retrospective study was to analyze the influence of D2-LA and/or splenectomy on the clinical course, morbidity and long-term survival of gastric cancer patients. METHODOLOGY: Included in this series are 243 consecutively treated gastric cancer patients with a median age of 63.8 years. RESULTS: Though 56% of the patients presented with stage III and IV tumors, a resection rate of 95.5% with R0-resections in 73.7% was achieved. D2-LA rate was 66.3% with simultaneous splenectomy in 48.7%. Global morbidity was 41.6%. Surgical morbidity, leakage and abscess rates after curative R0 resections were not influenced by D2-LA (22.5/6.5/6.5% vs. 21.9/9.1/3.0% +/- LA) but by splenectomy (31.6/13.2/11.8% vs. 14.7/2.1/1% +/- Sx). Simultaneous splenectomy was associated with 7 of 9 leakages, 7 of 9 abscesses, and 4 of 5 cases with postoperative pancreatitis. Long-term survival (Kaplan-Meier) was 40.6% for all, and 58.1% for R0 resected patients. It was not influenced by splenectomy (56/60.3% +/- Sx). CONCLUSIONS: Radical D2-LA has no impact on the morbidity of gastric cancer patients, but splenectomy is always linked with elevated complications without improving survival rates. Therefore splenectomy as potential part of D2-LA can only be advocated in patients with direct infiltration of pancreas or spleen, in stage IV or whenever metastatic spread is supposed in the nodes along splenic artery or hilum.

[Gastrectomy with radical D2 lymph node excision--effective and economically standardized therapy of adenocarcinoma of the stomach]. / Gastrektomie mit radikaler D2-Lymphadenektomie--effiziente und ökonomische Standardtherapie bei Adenokarzinomen des Magens.

In a retrospective single center study, the impact of radical D2-lymph adenectomy and splenectomy on operativ course, morbidity, mortality and long-term survival, in 243 patients who underwent radical surgical therapy for gastric cancer, was analyzed. D2-lymph node dissection during gastrectomy or gastric resection did not influence blood loss, artificial respiration time, ICU days or surgical morbidity, whereas splenectomy correlated with a higher hospital mortality, leakage and abscess rate. Due to routinely performed D2-lymphadenectomy long term survival rate (5 years) was 40.6% for all (in detail: 96% in stage IA; 68.5%/IB; 61.2%/II; 35.8%/IIIA; 17.3%IIIB; and 2.6% in stage IV and 58.1% for curative resected patients.

[Significant value and therapeutic implications of routine gastroscopy before cholecystectomy]. / Valeur significative et implications thérapeutiques de la gastroscopie de routine avant cholécystectomie.

Endoscopy of the upper digestive tract was performed in 338 consecutive patients undergoing cholecystectomy between January 1991 and December 1992. Pathological findings were seen in 160 (47.3%), 6.8% of the patients had peptic ulcers, 1.8% gastric erosions, 25.7% gastritis, 3.2% polyps, 4.7% hiatal hernias, 3.0% oesophagitis and 0.6% gastric cancer. In most patients the gastroscopic results did not correlate with the clinical symptoms. The therapy concept had to be changed in 8.3% of the patients due to gastroscopic findings, 23 patients with ulcers, 2 with erosions and 1 with oesophagitis had to be treated medically and so the cholecystectomy was postponed. Two patients with gastric cancer underwent gastrectomy. These results underline the importance of a routine gastroscopy before elective cholecystectomy.

Sepsis syndrome induced by tuberculous perforation of the esophagus.

Perforation of the esophagus induced by tuberculosis with no evidence of HIV infection is an extremely unusual presentation of the disease. We report on a 41-year-old man presenting with an esophageal perforation who developed a sepsis syndrome characterized by multiple organ dysfunction. The perforation was covered endoscopically with a tube, the patient recovered from cardiovascular, renal and pulmonary dysfunction under intensive care treatment, including antimycobacterial therapy. In response to endoscopic and medical treatment the size of the lesion decreased and disappeared 56 days after diagnosis. The patient could be discharged 2 months after admission and remained asymptomatic after a 12 month follow-up examination.

[Gastrectomy with radical lymphadenectomy--standard therapy of adenocarcinoma of the stomach]. / Gastrektomie mit radikaler Lymphadenektomie--Standardtherapie bei Adenokarzinom des Magens.

From January 1992 to December 1995, 208 patients with adenocarcinoma of the stomach were admitted for surgical treatment; total gastrectomy was performed in 152 patients. Improvement of survival rates in comparison to earlier European studies could be obtained by radical resection and routinely performed D2-lymphadenectomy without an increase in morbidity or hospital lethality. The results from Japanese researchers could not be reached.