%0 Journal Article
%T D1 versus Modified D2 Gastrectomy for Ca Stomach¡ªA Prospective and Comparative Study
%A Alfar Nafae
%A Raiees Ahmad
%A Amber Aliya
%A Yawar Nisar
%A Pervaze Salam
%A Imtiyaz Ahmad
%J Surgical Science
%P 13-26
%@ 2157-9415
%D 2016
%I Scientific Research Publishing
%R 10.4236/ss.2016.71002
%X Background: Carcinoma stomach remains a major malignancy and accounts for
10.4% of cancer related deaths globally. Despite improvement in chemo-radiotherapy,
surgery remains the primary curative modality with special emphasis on lymphadenectomy.
However the extent of lymphadenectomy performed by surgeons all over the world
differs. Generally speaking, in Japan and Korea, the standard curative protocol
would entail a ¡°D2¡± lymphadenectomy whereas in the western world it would be considered
unnecessary and the standard protocol would entail a standard ¡°D1¡±
lymphadenectomy. Thus prompting a newer surgical therapy of modified D2 in
dissection in which pancreas and spleen are preserved. Lymph nodes surrounding
stomach are divided into 20 stations and these are classified into three groups
depending upon the location of the primary tumour. Aims & Objectives: The
aims and objectives are to compare: 1) operative time of modified D2
gastrectomy with that of D1 gastrectomy; 2) operative morbidity and mortality
of modified D2 gastrectomy with that of D1 gastrectomy; 3) the disease
recurrence between modified D2 & D1 gastrectomy. Materials & Method:
The study entitled D1 versus modified D2 gastrectomy for Ca stomach¡ªa prospective,
comparative study was conducted in the Postgraduate Department of General
Surgery, Government Medical College, Srinagar as a prospective, comparative
study over a period of three years 2012-2014. Patients with resectable gastric
cancer were taken as subjects for the study and were divided in 2 groups that
were closely matched to avoid any bias. Assessment of both the groups was done
in identical fashion as per standard protocol. One group underwent gastrectomy
with D1 lymph node dissection whereas the other group underwent gastrectomy
with a modified D2 lymph node dissection (spleen and pancreas preservation).
The type of <a name=\"OLE_LINK22\"></a><a name=\"OLE_LINK21\"></a><span style=\"font-family:Verdana;\">lymphadenectomy was decided on
randomization (simple random sampling). Results: After comparing the two
procedures, it was noted that: 1) modified D2 lymphadenectomy took on an
average 2 hours more than D1 gastrectomy; 2) operative mortality was same in
both the procedures. Operative morbidity was seen more in modified D2 group
than D1 group however this difference was statistically insignificant; 3) number
of recurrence was quite significant in D1 group but no recurrence was seen in
modified D2 group. Conclusion: On the basis of the study, we recommend that
modified D2 gastrectomy is a better procedure than D1
%K Carcinoma Stomach
%K Gastrectomy Curative Resection
%K Lymphnode Dissection
%U http://www.scirp.org/journal/PaperInformation.aspx?PaperID=62708