The Effect of Extended Dissection of Lymph Nodes (D2plus) with Gastrectomy on the Clinical and Oncological Outcomes in Gastric Cancer Patients, Compared to a Standard Dissection (D2)
<i>Background and Objectives</i>: Gastric cancer treatment of partial or complete gastrectomy includes lymph nodes dissection (D2) to remove microscopic lymph node metastases adjacent to the tumor. A more extensive approach, an extended dissection (D2plus) has recently been employed, whi...
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2025-07-01
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| author | Sahar Lazari Muhammad Masalha Forat Swaid Walid Shalata Gideon Sroka Weam Waked Abed Agbarya |
| author_facet | Sahar Lazari Muhammad Masalha Forat Swaid Walid Shalata Gideon Sroka Weam Waked Abed Agbarya |
| author_sort | Sahar Lazari |
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| description | <i>Background and Objectives</i>: Gastric cancer treatment of partial or complete gastrectomy includes lymph nodes dissection (D2) to remove microscopic lymph node metastases adjacent to the tumor. A more extensive approach, an extended dissection (D2plus) has recently been employed, which includes resection of the lymph nodes in the pancreatic and periportal areas. However, despite its potential benefits of longer survival for patients diagnosed with advanced cancer, there are increased risks due to surgical complications. The current study aims to examine the balance between clinical benefit and higher risks of the extended dissection approach versus standard dissection. <i>Materials and Methods</i>: This retrospective analysis of gastric cancer patients treated in Bnai-Zion medical center examined the survival rates, oncological outcomes, and complication rates according to medical records data files. <i>Results</i>: The D2plus group experienced increased postoperative complications rate (56% vs. 20.6% D2 group <i>p</i> = 0.005) with mean survival time, shorter than the D2 standard approach (2.07 years vs. 3.44 years <i>p</i> = 0.01). A higher number of lymph nodes was removed on average in the D2plus group (29.4 ± 11.2), but without statistical significance in comparison to the D2 group (22.6 ± 8.9, <i>p</i> = 0.013). D2plus patients had reduced disease recurrence rates (20% vs. 32.4% in D2 group <i>p</i> = 0.29). Weight loss of D2plus patients was noted for higher rates than the D2 group (40% vs. 17.6% <i>p</i> = 0.056. <i>Conclusions</i>: Our study provides preliminary insights into the comparison between D2 and D2plus dissection in a single-center Western cohort. However, significant baseline differences between groups, particularly age, gender, and histopathological characteristics, limit definitive conclusions. The findings should be interpreted as hypothesis-generating rather than practice-changing. Larger, prospective, multicenter studies with propensity score matching or randomized design are needed to definitively establish the optimal surgical approach for different patient subgroups. |
| format | Article |
| id | doaj-art-780b260cad734d5dbb2a660ee95680ad |
| institution | Kabale University |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2025-07-01 |
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| series | Medicina |
| spelling | doaj-art-780b260cad734d5dbb2a660ee95680ad2025-08-20T03:36:14ZengMDPI AGMedicina1010-660X1648-91442025-07-01617128410.3390/medicina61071284The Effect of Extended Dissection of Lymph Nodes (D2plus) with Gastrectomy on the Clinical and Oncological Outcomes in Gastric Cancer Patients, Compared to a Standard Dissection (D2)Sahar Lazari0Muhammad Masalha1Forat Swaid2Walid Shalata3Gideon Sroka4Weam Waked5Abed Agbarya6Department of Pediatric Surgery, Rambam Health Care Campus, 8 HaAliya HaShniya Street, Haifa 3109601, IsraelDepartment of Surgery, Tzafon Medical Center, Poriya 1528001, IsraelDepartment of Surgery, Tzafon Medical Center, Poriya 1528001, IsraelThe Legacy Heritage Cancer Center, Dr. Larry Norton Institute, Soroka Medical Center, Ben-Gurion University, Beer Sheva 84105, IsraelDepartment of Surgery, Bnai-Zion Medical Center, 47 Eliyahu Golomb Avenue, Haifa 3339419, IsraelDepartment of Surgery, Bnai-Zion Medical Center, 47 Eliyahu Golomb Avenue, Haifa 3339419, IsraelInstitute of Oncology, Bnai-Zion Medical Center, 47 Eliyahu Golomb Avenue, Haifa 3339419, Israel<i>Background and Objectives</i>: Gastric cancer treatment of partial or complete gastrectomy includes lymph nodes dissection (D2) to remove microscopic lymph node metastases adjacent to the tumor. A more extensive approach, an extended dissection (D2plus) has recently been employed, which includes resection of the lymph nodes in the pancreatic and periportal areas. However, despite its potential benefits of longer survival for patients diagnosed with advanced cancer, there are increased risks due to surgical complications. The current study aims to examine the balance between clinical benefit and higher risks of the extended dissection approach versus standard dissection. <i>Materials and Methods</i>: This retrospective analysis of gastric cancer patients treated in Bnai-Zion medical center examined the survival rates, oncological outcomes, and complication rates according to medical records data files. <i>Results</i>: The D2plus group experienced increased postoperative complications rate (56% vs. 20.6% D2 group <i>p</i> = 0.005) with mean survival time, shorter than the D2 standard approach (2.07 years vs. 3.44 years <i>p</i> = 0.01). A higher number of lymph nodes was removed on average in the D2plus group (29.4 ± 11.2), but without statistical significance in comparison to the D2 group (22.6 ± 8.9, <i>p</i> = 0.013). D2plus patients had reduced disease recurrence rates (20% vs. 32.4% in D2 group <i>p</i> = 0.29). Weight loss of D2plus patients was noted for higher rates than the D2 group (40% vs. 17.6% <i>p</i> = 0.056. <i>Conclusions</i>: Our study provides preliminary insights into the comparison between D2 and D2plus dissection in a single-center Western cohort. However, significant baseline differences between groups, particularly age, gender, and histopathological characteristics, limit definitive conclusions. The findings should be interpreted as hypothesis-generating rather than practice-changing. Larger, prospective, multicenter studies with propensity score matching or randomized design are needed to definitively establish the optimal surgical approach for different patient subgroups.https://www.mdpi.com/1648-9144/61/7/1284gastric cancersurgerydissectionlymph nodessurvivalrecurrence |
| spellingShingle | Sahar Lazari Muhammad Masalha Forat Swaid Walid Shalata Gideon Sroka Weam Waked Abed Agbarya The Effect of Extended Dissection of Lymph Nodes (D2plus) with Gastrectomy on the Clinical and Oncological Outcomes in Gastric Cancer Patients, Compared to a Standard Dissection (D2) Medicina gastric cancer surgery dissection lymph nodes survival recurrence |
| title | The Effect of Extended Dissection of Lymph Nodes (D2plus) with Gastrectomy on the Clinical and Oncological Outcomes in Gastric Cancer Patients, Compared to a Standard Dissection (D2) |
| title_full | The Effect of Extended Dissection of Lymph Nodes (D2plus) with Gastrectomy on the Clinical and Oncological Outcomes in Gastric Cancer Patients, Compared to a Standard Dissection (D2) |
| title_fullStr | The Effect of Extended Dissection of Lymph Nodes (D2plus) with Gastrectomy on the Clinical and Oncological Outcomes in Gastric Cancer Patients, Compared to a Standard Dissection (D2) |
| title_full_unstemmed | The Effect of Extended Dissection of Lymph Nodes (D2plus) with Gastrectomy on the Clinical and Oncological Outcomes in Gastric Cancer Patients, Compared to a Standard Dissection (D2) |
| title_short | The Effect of Extended Dissection of Lymph Nodes (D2plus) with Gastrectomy on the Clinical and Oncological Outcomes in Gastric Cancer Patients, Compared to a Standard Dissection (D2) |
| title_sort | effect of extended dissection of lymph nodes d2plus with gastrectomy on the clinical and oncological outcomes in gastric cancer patients compared to a standard dissection d2 |
| topic | gastric cancer surgery dissection lymph nodes survival recurrence |
| url | https://www.mdpi.com/1648-9144/61/7/1284 |
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