Abstract
The controversy over the value of extended lymph node dissection for treatment of gastric cancer is fiercely debated. Whereas Japanese surgeons claim that the superior survival rates in their series are due to extensive resection (D2 resection), many Western authorities believe that their results only reflect differences in the prevalence of prognostic factors, inconsistencies between Japanese and Western staging systems, and the phenomenon of “stage migration,” which occurs with extensive resection. Two small randomized prospective trials from Hong Kong and Cape Town showed a tendency toward high morbidity with extensive lymph node dissection but no survival benefit. In contrast, the recently completed prospective German Gastric Carcinoma Study demonstrated a clear survival advantage with D2 resection for tumor stages II and IIIa with no increase in perioperative morbidity or mortality. The long-term results of the still ongoing randomized MRC and Dutch trials are therefore eagerly awaited.
Résumé
La controverse concernant le curage ganglionnaire étendu dans le traitement du cancer gastrique est vivement débattue. Alors que les chirurgiens japonais clament que la survie est améliorée justement à cause de l'étendue de la résection (dite D2), beaucoup d'experts de l'Occident croient que cette apparente supériorité reflète seulement la différence dans la prévalence des facteurs pronostiques, les différences des systèmes de classification entre l'Occident et l'Orient ainsi que le phénomène de 《migration de stade》 qui est une conséquence des résections étendues. Deux essais randomisés provenant de Hong Kong et du Cap ont démonté une tendance vers une morbidité élevée en cas de dissection plus poussée mais sans supériorité de survie. En contraste, l'étude prospective allemande nommée 《German Gastric Carinoma Study》 a démontré une nette amélioration de survie par la résection D2 pour les tumeurs de stade II et IIIa sans augmentation de la morbidité ou de la mortalité périopératoires. Les résultats à long terme d'autres essais randomisés, toujours en cours, des groupes MRC et Hollandais, sont attendus avec impatience.
Resumen
La controversia sobre el valor de la disección ganglionar radical en el tratamiento del cáncer gástrico es motivo de fiero debate. En tanto que los cirujanos japoneses proclaman que sus mejores tasas de sobrevida se deben a la resección radical (resección D-2), muchas autoridades de Occidente creen que ello sólo refleja diferencias en la prevalencia de factores de pronóstico, inconsistencias entre los sistemas de estadificación del Japón y de Occidente y el fenómeno de la “migración del estadío” que se observa con las resecciones más extensas. Dos pequeños ensayos clínicos prospectivos y randomizados provenientes de Hong Kong y de la Ciudad del Cabo han demostrado una tendencia hacia una más alta morbilidad con la disección radical y ningún beneficio en cuanto a sobrevida. En contraste, el reciente Estudio Prospectivo Alemán sobre cáncer gástrico demostró clara ventaja con la resección D-2 para los estados II y IIIa sin incremento de la morbilidad y la mortalidad perioperatorias. Los resultados a largo plazo del estudio randomizado MRC y del estudio holandés, que están en progreso, son esperados con gran expectativa.
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Roder, J.D., Bonenkamp, J.J., Craven, J. et al. Lymphadenectomy for gastric cancer in clinical trials: Update. World J. Surg. 19, 546–553 (1995). https://doi.org/10.1007/BF00294718
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DOI: https://doi.org/10.1007/BF00294718