Results of D2 gastrectomy for gastric adenocarcinoma: 10-Year experience in Thai patients

Background: The therapeutic value of D2 gastrectomy in the curative treatment of gastric adenocarcinoma is controversial outside Japan. Material and Method: The authors retrospectively reviewed the medical records of 97 patients with gastric adenocarcinoma who underwent curative D2 gastrectomy between October 1995 and September 2005. Results: Subtotal gastrectomy was performed in 42/97 patients (43%) and total gastrectomy in 55/97 patients (57%), with an average number of 38 lymph nodes (range, 22-82) and 48 lymph nodes (range, 24-126) removed, respectively. Overall morbidity rate was 17% (16/97). There was no hospital mortality. The 5-year overall and 5-year disease-free survival rates were 59% and 46%, respectively. The 5-year disease-free survival rate for each TNM stage was 100% for stages IA and IB, 75% for stage II, 78% for stage IIIA, 28% for stage IIIB and 4% for stage IV. Of the 43/97 patients (44%) who had metastasis to the level 2 (N2) lymph nodes, 14/43 patients (33%) survived more than 5 years. Conclusion: The D2 gastrectomy can be performed with low morbidity and mortality, and may increase the cure rate and survival of Thai gastric adenocarcinoma patients, at least in experienced centers.