D2 lymph node dissection confers little benefit on the overall survival of older patients with resectable gastric cancer
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ORIGINAL ARTICLE
D2 lymph node dissection confers little benefit on the overall survival of older patients with resectable gastric cancer: a propensity score‑matching analysis of a multi‑institutional dataset Takahiro Shinozuka1,2,3 · Mitsuro Kanda2 · Seiji Ito4 · Yoshinari Mochizuki3 · Hitoshi Teramoto5 · Kiyoshi Ishigure6 · Toshifumi Murai1 · Takahiro Asada7 · Akiharu Ishiyama8 · Hidenobu Matsushita9 · Chie Tanaka2 · Daisuke Kobayashi2 · Michitaka Fujiwara2 · Kenta Murotani10 · Yasuhiro Kodera2 Received: 5 February 2020 / Accepted: 28 April 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose Aging societies comprise an increasing number of elderly gastric cancer (GC) patients. We herein attempted to determine whether D2 lymphadenectomy is beneficial for older GC patients. Methods We retrospectively analyzed a multi-institutional dataset including 3484 patients who received surgical resection for GC. For the analysis, we selected patients aged ≥ 80 years who were clinically diagnosed with T1N + or T2-4 GC. To balance the essential variables including the type of gastrectomy and the stage of progression, propensity score matching was conducted, and we compared the background clinical factors and postoperative outcomes of the patients allocated to the D2 (n = 87) and non-D2 (n = 87) dissection groups. Results The D2 group had significantly longer operative times, more blood loss, and more retrieved lymph nodes (median 32 vs 24, P 50 gastrectomies for gastric cancer annually in accordance with the Japanese gastric cancer treatment guidelines [12]. Surgeons having board certifications from the Japanese Society of Gastroenterological Surgery either performed or supervised all surgeries.
Analysis of clinical parameters The clinicopathological features included age, sex, body mass index (BMI, kg/m [2]), performance status, comorbidities, preoperative blood transfusion, prognostic nutritional index (PNI = 10 × albumin g/dL + 0.005 × total lymphocyte count/mm3), [17] hemoglobin (g/dL), estimated glomerular filtration rate (eGFR), carbohydrate antigen 19–9 (CA 19–9, ng/mL), carcinoembryonic antigen (CEA, ng/mL) and anticoagulants. The clinical and pathological tumor depth, nodal involvement, and stage classification were determined according to the Union for International Cancer Control (UICC), eighth edition [18]. The surgical data included the operation time, blood loss, lymph node harvested, days hospitalized, morbidity (graded according to the ClavienDindo classification) [19], and repeat surgery during hospitalization. The causes of death and sites of recurrence were compared.
Results Patients’ baseline characteristics The patients’ backgrounds before and after propensity score matching are shown in Table 1. After one-to-one matching, the age, sex, performance status, cardiopulmonary comorbidities, diabetes mellitus, clinical T classification, clinical N classification and type of gastrectomy were balanced (Table 1). The patients’ demographics after propensity score matching were presented in Table
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