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DOI: 10.1055/s-2007-958714
© Georg Thieme Verlag KG Stuttgart · New York
Systematische Lymphadenektomie beim Magenkarzinom -Prognoseverbesserung oder Risikoerhöhung ?
Systematic Lymphadenectomy in Gastric Cancer - Impact on Prognosis and Perioperative RiskPublication History
Publication Date:
23 March 2007 (online)
![](https://www.thieme-connect.de/media/viszeralchirurgie/200701/lookinside/thumbnails/10.1055-s-2007-958714-1.jpg)
Zusammenfassung
Einleitung: Die Diskussion zur D2-Dissektion beim Magenkarzinom wird hinsichtlich ihrer prognostischen Relevanz und ihres perioperativen Risikos (Morbidität/Letalität) kontrovers geführt. Patienten und Methoden: In Analyse prospektiv dokumentierter Daten wurde das Langzeitüber-leben und die perioprative Morbidität und Letalität R0-resezierter Patienten (1986-2000) in Abhängigkeit vom Ausmass der LK-Dissektion untersucht. Ergebnisse: Von 281 R0-resezierten Patienten wurden 143 mit D2- und 138 mit D1-Dissektion operiert. Beide Gruppen wiesen keine Unterschiede in der perioperativen Komplikations- (36% vs. 38%) und Letalitätsrate auf (4% vs. 5%). Eingriffserweiterungen hingegen führten zu einer signifikanten Zunahme perioperativer Komplikationen (45% vs. 30%; p=0.008). Im Gesamtkollektiv unterschied sich das 5-Jahresüberleben von D2- und D1-Dissezierten nicht wesentlich (49% vs. 43%; p=0.283). Subgruppenanalysen zeigten divergierende Ergebnisse. Bei 74 Patienten mit höheren Tumorstadien (pTX pN2/3) war der Unterschied im 5-Jahresüberleben zwischen D2- und D1-Dissezierten nicht signifikant (16% vs. 5%; p=0.249), während von 207 Patienten mit niedri-geren Tumorstadien (pTX pN0/1) die D2-Dissezierten ein signifikant besseres 5-Jahresüberleben aufwiesen (68% vs. 50%; p=0.003). Dies traf vor allem auf die jüngeren Patienten (<65 Jahre; n=96) zu, deren 5-Jahresüberlebensrate 84% bei D2- und 57% bei D1-Dissektion betrug (p<0.001), während sich bei den älteren Patienten (>65 Jahre; n=111) keine wesentlichen Unter-schiede fanden (48% vs. 45%; p=0.847). Schlussfolgerung: Eine D2-Dissektion ist nicht zwangsläufig mit einer erhöhten perioperativen Morbidität/Letalität verbunden und scheint bei Patienten mit fehlendem oder moderatem LK-Befall (pN0-1) eine Prognoseverbesserung zu bewirken. Sie sollte somit die Standardradikalität bei jedem mit kurativem Anspruch operierten Patienten sein.
Abstract
D2-Lymphadenectomy in gastric cancer: Prognostic benefit or increased perioperative risk? The discussion about prognostic relevance and perioperative morbidity and mortality in gastric cancer surgery caused by systematic lymphadenectomy (D2-dissection) is still controversial. The impact of D2- and D1-dissection on long term survival and perioperative morbidity and mortality was evaluated analysing prospectively documentated data of 281 R0-resected gastric cancer patients (time period: 1986-2000; sex ratio: m:f=2:1; mean age: 64 years). Perioperative morbidity (36% vs 38%) and hospital mortality (4% vs 5%) did not differ significantly between D2- and D1-dissection groups. In contrast, perioperative morbidity increased significantly in multivisceral surgery from 30% to 45% (p=0.008) and perioperative mortality was doubled (3% vs 6%; p=0.293). D2-dissection was carried out in 143 patients and 138 patients were treated with D1-dis-section. Comparing all 281 R0-resected patients we did not find significant differences in 5-year survival (49% vs 43% p=0.283) between both groups. In subgroup analysis patients with pTX pN2/3 tumor stages (n=74) did not significantly benefit from D2-dissection (5 year survival: 16% vs 5%; p=0.249). However, the 207 patients with pTXpN0/1 tumor stages demonstrated a signi-ficantly better 5 year survival rate following D2-dissection (68% vs 50%; p=0.003). Especially patients younger than 65 years of age (n=96) with pTXpN0/1 tumor stages took advantage from D2-dissection. The 5 year survival was 84% in 49 D2- and 57% in 47 D1-dissections (p<0.001). In 111 pTXpN0/1 patients older than 65 years of age the long term survival between D2- and D1-dissection groups was not significantly different (48% vs 45%; p=0.847). D2-dissection should be carried out in all gastrectomies with curative intent, because perioperative morbidity and mortality are not increased by D2-dissection and long term survival is improved in patients having no lymphnode metastases (pTXpN0) or only a moderate lymphnode involvement (pTXpN1).
Schlüsselwörter
Magenkarzinom - D2-Dissektion - Morbidität und Letalität - Langzeitprognose
Key words
Gastric cancer - D2-lymphadenectomy - morbidity and mortality - long term survival
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Korrespondenzadresse
Prof. Dr. H.-D. Röher
em. Direktor der Klinik für Allgemein- und Unfallchirurgie
Klinikum der Heinrich-Heine-Universität
Moorenstrasse 5
40225 Düsseldorf
Phone: +49/211/811 73 75
Fax: +49/211/811 94 08
Email: roeher@med.uni-duesseldorf.de