Why do reports from large volume single institutions continue to demonstrate low operative mortalities, short hospital stays, and prolonged patient survivals for patients with gastric cancer treated by D2 lymphadenect...
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Why do reports from large volume single institutions continue to demonstrate low operative mortalities, short hospital stays, and prolonged patient survivals for patients with gastric cancer treated by D2 lymphadenectomy when randomized trials show no survival advantage and increased operative mortality with this procedure? Should gastric cancer resections be added to the growing list of procedures with reduced mortality and improved survivorship when performed in high-volume institutions? Although not a randomized trial, the report by Dr. Sierra and colleagues from the University of Navarra in Paploma, Spain, adds credence to the concept that D2 resections can be performed safely and provide enhanced survival when performed in high-volume hospitals by a small group of experienced surgeons.1,2 The D2 dissection that they performed included total gastrectomy and splenectomy but did not require resection of the tail of the pancreas as performed in the Dutch and British randomized trials.3,4 Instead, lymph nodes along the splenic artery (station 11 in the Japanese classification) were usually dissected away from surrounding tissues to be included with the resected specimen. Pancreatic fistulas did occur in three of the eight D2 patients who required pancreatic resection. This suggests that, in the randomized trials, the pancreatic resection, rather than the splenectomy and the D2 lymphadenectomy, was the major cause of the excess operative mortality in the D2 group.3,4
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