Utility Of "Over D1" Or D1 Nodal Dissections In Predicting Outcome Of Patients With Gastric Adenocarcinoma Treated With Postoperative Concurrent Chemoradiotherapy

Abstract

We retrospectively evaluated the utility "over D1" or D1 dissections on outcome of gastric cancer patients with subsequent postoperative chemoradiotherapy. Sixty-five patients with gastric adenocarcinoma treated with postoperative concurrent chemoradiotherapy were evaluated. Inclusion criteria were total or subtotal gastrectomy with a cut-point of >= 10 nodes dissected in the surgery without scheduled splenectomy and pancreatectomy. Nodal dissections grouped according to Japanese Research Society; N1 stations (1-6) as D1, and dissection of additional stations (7-9) as "over D1". The median follow-up was 30 months. Surgery was total gastrectomy in 32 patients and subtotal in 33. Nodal dissection was D1 in 36 (55.4%) patients and over D1 in 29 (44.6%). The 2-year overall, local recurrence free, distant metastasis free, and disease free survivals of the entire group of patients were 83.3%, 89.9%, 68.4%, 62.5% respectively. Two year distant metastasis free survival was %55 for D1 and %88.5 for "over D1" dissected patients (p= 0.06). Overall survival was significantly longer in "over D1" dissected patients (2 year overall survival: 72.3% for D1 and 96% for "over D1", p= 0.05). Moreover, disease specific survival was significantly longer in "over D1" dissected patients (2 year disease specific survival: 72.3% for D1 and 100% for "over D1", p= 0.02). No grade 3-4 acute or late toxicity was observed. In conclusion, our retrospective data showed that over D1 dissected patients treated with concomitant chemoradiotherapy seemed to gain additional survival benefit in comparison to D1 dissected patients in this retrospective cohort with no significant extra toxicity.