Morbidity after D2 and D3 gastrectomy for node-positive gastric carcinoma

BACKGROUND: Several studies show various rates of morbidity and mortality after radical operation for gastric carcinoma, Whether or not extended lymph node dissection should be done is still controversial. STUDY DESIGN: The medical records of 214 patients with node-positive gastric carcinoma who underwent radical gastrectomy and extended lymph node dissection (D2, D3) from 1975 to 1990 were analyzed with reference to the type and cause of postoperative complications. RESULTS: The overall morbidity rate was 36 percent and was significantly different between patients with distal gastrectomy (19 percent) and total gastrectomy (53 percent) (p<.01). Morbidity after distal gastrectomy correlated with blood loss (593 g compared with 438 g; p<.05) and transfusion (43 percent compared with 21 percent; p<.05), whereas morbidity after total gastrectomy was closely linked to splenectomy (64 percent compared with 40 percent; p<.05) and duration of the operation (227 minutes compared with 204 minutes; p<.05). The morbidity rate was not different, however, between D2 dissection (33 percent) and D3 dissection (40 percent) groups. CONCLUSIONS: Radical gastrectomy and extended lymph node dissection can be performed with an acceptable morbidity, but total gastrectomy with splenectomy was associated with high morbidity in patients with node-positive gastric carcinoma.