The Clinical Study Of D2 Nodal Dissection For Gastric Cancer And Review Of Literatures

Background And ObjectiveThe incidence of gastric cancer has decreased in the latest decades in worldwide range. However,gastric cancer is still one of the most common malignant cancers that damage human health.After therapeutic research in the past one more century, surgery is still the main method to treatgastric cancer, which may be also the unique way of curing gastric cancer. Lymph node cleaningscope is also the hot subject under debate. For a long time, there are arguments for the lymphnode cleaning scope between the eastern countries and western countries. Japan, on behalf of theeastern countries, they consider that lymph node cleaning is critical to surgical treatment, whichis closely related with the prognosis, and advocate extended lymph node dissection(ELND),andmakes D2 node dissection as the standard radical operation. And ELND is proved to improve the5 years surviving rate by many retrospective studies. However, most of the European countriesand South Africa hold different opinions. The conclusion they generated from the randomizedcontrolled trail (RCT) was against that of the Japanese researchers. This paper analyses theclinical material of D2 nodal dissection, which has been performed on 32 patients sufferinggastric cancer in the department of general surgery in our hospital since 2008. The purpose toevaluate the feasibility and the security of D2 nodal dissection, and discuss the rationality and thenormalization of the surgery treatment for gastric cancer.Clinic material and methodD2 nodal dissection of gastric cancer has been performed on 32 patients suffering gastric cancerin the department of general surgery in our hospital since November 2008. All the cases collectedwere proved to suffer gastric cancer by gastroscopy and endoscopic biopsy before the surgery.And clinic stages of gastric cancer were obtained through CT scanning before the surgery tomake sure the cases were curable. D2 nodal dissection of gastric cancer were all successfully performed on these 32 patients, data of time of hospitalization,time of the surgery,hemorrhage during the surgery,lymph node cleaning quantity,postoperative complications were collected. And periodical Imaging examination and serial tumor marker were carried out in the follow-up study ranging from 3 ~ 15 month.ResultWe make the mean hospitalization time as (16.9 + 2. 9)d, mean surgical time as (238.5 + 64. 4)min, mean amount of hemorrhage during surgery as (234 + 80. 2)ml, mean amount of the removed lymph node as (19.7 + 6. 3). No specific postoperative complications were observed. Imaging examination and test of serial tumor makers in the follow-up study didn't show any clue of recurrence of gastric cancer. All the patient had normal diet.Conclusion1 D2 nodal dissection of gastric cancer is safe and feasible.2 Lymph node cleaning scope of gastric cancer should obey the Japanese General Rules for the Gastric cancer Study(13th edition). The lymph node of No.7,No.8a and No.9 should be removed.3 D2 nodal dissection of gastric cancer supplies accurate evidence for the clinic TNM stages and the postoperative comprehensive treatment.