Necessity of D2 lymph node dissection in older patients ≥80years with gastric cancer

Abstract

Objectives: This study analyzed the effect of D2 lymph node (LN) dissection on complications and survival in older patients with gastric cancer.

Materials and methods: A total of 103 octogenarian patients who underwent curative gastrectomy for gastric cancer were divided into two groups (D2 and D1) according to the extent of LN dissection and analyzed retrospectively for complications and survival.

Results: No differences were observed in short-term postoperative outcomes, including complication rates, between the two groups. In a survival analysis, D2 LN dissection did not improve overall survival (OS) in any patient, including advanced cases. A Cox regression analysis revealed that the independent risk factors for OS were history of coronary artery disease (hazard ratio [HR], 11.095), postoperative short-term complications (HR, 9.939), and TNM stage (HR, 6.299). The extent of LN dissection was not an independent risk factor for OS, and D2 or more LN dissection (odds ratio, 10.89) increased the risk independently.

Conclusions: D2 or more LN dissection did not improve survival, but rather increased the risk of complications. Thus, LN dissection should be performed sparingly in octogenarian patients with gastric cancer.

Keywords: Geriatric surgery; Lymph node dissection; Octogenarians; Postoperative complications; Survival.