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The short- and long-term outcomes of laparoscopic D2 lymphadenectomy plus complete mesogastrium excision for lymph node-negative gastric cancer

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Abstract

Background

Patients with T1-3N0M0 gastric cancer (GC) who undergo radical gastrectomy maintain a high recurrence rate. The free cancer cells in the mesogastric adipose connective tissue (Metastasis V) maybe the reason for recurrence in these individuals. We aimed to evaluate whether D2 lymphadenectomy plus complete mesogastrium excision (D2 + CME) was superior to D2 lymphadenectomy with regard to safety and oncological efficacy for T1-3N0M0 GC.

Methods

Patients with T1-3N0M0 GC who underwent radical resection from January 2014 to July 2018 were retrospectively analyzed; there were 323 patients, of whom 185 were in the D2 + CME group and 138 in the D2 group. The primary endpoint was 5-year disease-free survival (DFS). Secondary endpoints include the 5-year overall survival (OS), recurrence pattern, morbidity, mortality, and surgical outcomes.

Results

D2 + CME was associated with less intraoperative bleeding loss, a greater number of lymph nodes harvested, and less time to first postoperative flatus, but the postoperative morbidity was similar. The 5-year DFS was 95.6% (95% CI 92.7–98.5%) and 90.4% (95% CI 85.5–95.3%) in the D2 + CME group and the D2 group, respectively, with a hazard ratio (HR) of 0.455 (95% CI 0.188–1.097; p = 0.071). In terms of recurrence patterns, local recurrence was more prone to occur in the D2 group (p = 0.031). Subgroup analysis indicated that for patients with T1b-3N0M0 GC, the 5-year DFS in the D2 + CME group was considerably greater than that in the D2 group (95.3% [95% CI 91.6–99.0%] vs. 87.6% [95% CI 80.7–94.5%], HR 0.369, 95% CI 0.138–0.983; log-rank p = 0.043).

Conclusion

Laparoscopic D2 + CME for T1-3N0M0 GC is safe and feasible. Furthermore, it not only reduces the local recurrence rate but also improves the 5-year DFS in cases of T1b-3N0M0 GC.

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Data availability

The data sets used or analyzed in this study are available from the corresponding author on reasonable request.

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Acknowledgments

Thank American Journal Experts (AJE) for proofreading the English grammar and spelling of our paper.

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Author notes

  1. Zhiming Cai and Huimei Lin have contributed equally to this work and are co-first authors.

Authors and Affiliations

  1. The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China

    Zhiming Cai, **feng Zhou, Weixiang Chen, Feng Liu & Hongrui Zhao

  2. Gastrointestinal Surgery Unit 1, The First Hospital of Putian City, Putian, 351100, Fujian, China

    Zhiming Cai, Zhixiong Li, **feng Zhou, Weixiang Chen, Feng Liu, Hongrui Zhao & Yanchang Xu

  3. Department of Anorectal Surgery, The Second Affiliated Hospital of **amen Medical College, **amen, 361021, Fujian, China

    Huimei Lin

  4. Putian University, Putian, 351100, Fujian, China

    Zhiming Cai, **feng Zhou, Weixiang Chen, Feng Liu & Hongrui Zhao

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Contributions

Conception and design: ZMC, YCX. Performed the research and acquired the data: ZMC, HML, ZXL, JFZ, WXC, FL, HRZ, YCX. Analyzed the data: ZMC, HML. Manuscript writing: ZMC, HML, YCX. Final approval of manuscript: All authors.

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Correspondence to Yanchang Xu.

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Zhiming Cai, Huimei Lin, Zhixiong Li, **feng Zhou, Weixiang Chen, Feng Liu, Hongrui Zhao and Yanchang Xu have no conflicts of interest or financial ties to disclose.

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Cai, Z., Lin, H., Li, Z. et al. The short- and long-term outcomes of laparoscopic D2 lymphadenectomy plus complete mesogastrium excision for lymph node-negative gastric cancer. Surg Endosc 38, 1059–1068 (2024). https://doi.org/10.1007/s00464-023-10621-w

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