Does D2 Plus PAND Surgery Offer A Better Survival Outcome Compared To D2 Surgery Only For Gastric Cancer Consistently?

ObjectiveCurative resection is the treatment of choice for gastric cancer, but it is unclear whether this operation should include a D2 plus PAND dissection, or a D2 dissection only. We conducted a retrospective study in our hospital in which we compared D2 with D2 plus PAND lymphadenectomy for gastric cancer in terms of long-term survival after surgery.MethodsWe selected 256 patients having undergone the treatment with curative intent between 1980 and 2003,192 in the D2 group and 64 in the D2 plus PAND group. Every procedure was verified by pathological analyses. The primary endpoints were 5-year overall survival.ResultsMedian follow-up periods were 28 months assigned to D2 group and 35 months assigned to D2 plus PAND group. Overall 5-year survival was not significantly higher in patients assigned D2 plus PAND surgery than in those assigned D2 surgery [31.2% (95% CI,19.8% to 42.6%) vs 26.6%(95% CI,20.3% to 32.9%); log-rank, p=0.433].ConclusionsD2 plus PAND surgery should only be used for curable gastric cancer of T3-4 and N2 stage and should not be used for T1 disease and total gastrectomy.