Abstract

CASTRO, Osvaldo Antonio Prado et al. Prognostic factors in D2 gastrectomy for gastric adenocarcinoma. ABCD, arq. bras. cir. dig. [online]. 2009, vol.22, n.3, pp.158-164. ISSN 0102-6720.  http://dx.doi.org/10.1590/S0102-67202009000300005.

BACKGROUND: Lymphatic spread is more common in gastric cancer than the hematogenic one. Thus, the locoregional dissection type D2 seems to be important. AIM: To evaluate the overall survival after D2 gastrectomy for gastric adenocarcinoma and to determine the most important prognostic factors, including those with independent statistical value. METHODS: Prospective study with 125 patients operated between August 1997 and October 2005. The technique employed followed strictly the protocol of the National Cancer Center - Tokyo. RESULTS: There were 73 men and 52 women with ages ranging 28 to 84 years (mean of 58.96 ± 14.01). Seventy per cent of the lesions were located at the distal portion of the stomach, 20% were proximal and 10% comprised the whole organ. The stage distributions were: I - 37 cases (29.6%), II - 20 cases (16%), III - 37 cases (29.6%), and IV - 31 cases (24.8%). It was performed the amount of 73 subtotal gastrectomies and 52 totals. The morbidity rate was 26.4%, mainly, due to leakage and pulmonary complications. The overall mortality rate was 9.6%. After a mean follow-up of 48 months, 68 (54.4%) patients were dead, representing an overall survival rate of 45.6%. Univariate and multivariate statistical analysis revealed that: tumors comprising the whole stomach, beyond the serosal layer (T3 or T4), with more than seven metastatic lymph nodes (N2 or N3), with distant metastasis (M1), and belonging to the stage III or IV of the disease, were related to a poor prognosis. CONCLUSIONS: Less than a half of the patients were alive after a mean follow-up of almost four years; the TNM stage system was the main prognostic factor, ergo, the extension of the lesions, the stage of the disease, metastatic occurrence and mainly the lymph node involvement were define as an independent prognostic factors.

Keywords : Stomach neoplasm; Adenocarcinoma; Gastrectomy; Lymph node excision; Prognosis.

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