Mortality and Morbidity and Disease Free Survival after D1 and D2 Gastrectomy for Stomach Adenocarcinomas


Background: A number of randomized trials addressing alternative operative and multimodality approachesto gastric cancer have characterized early postoperative morbidity and mortality rates. The aim of this study wasto compare mortality and morbidity and disease free survival after D1 and D2 gastrectomy for adenocarcinomasof the stomach Materials and
Methods: From June 2006 to January 2012, patients were selected according toinformation of the cancer administrator center of Ahvaz Jundishapur Medical University. The inclusion criteriawere age between 20-85 years and histologically proven adenocarcinoma of the stomach without evidence ofdistant metastasis. Patients were excluded if they had previous or coexisting cancer or disability disease. In thisresearch, D1 was compared to D2 gastrectomy.
Results: 131 patients were randomised, 49 allocated to D1 and 82to D2 gastrectomy. The two groups were comparable for age, sex, site of tumors, and type of resection performed.The overall post-operative morbidity rate was 17.5%. Complications developed in 14.2% of patients after D1and in 19.5% of patients after D2 gastrectomy (p=0.07). Postoperative mortality rate was 0.8% (one death); itwas 2% after D1 and 0% after D2 gastrectomy. In this research disease free-survival after 3 years was 71.2 %with 63.2% after D1 and 76.8% after D2 gasterctomy.
Conclusions: This study indicates that D2 gastrectomywith pancreas preservation is not followed by significantly higher morbidity and mortality than D1 resection.Based on the results of present study, D2 resection should be recommended as the standard surgical approachfor resectable gastric cancer.