Background: Gastric cancer is a leading cause of death in the developed world. Gastrectomy with D2 lymphadenectomy is the standard operation for the radical treatment of the disease, although high morbidity and mortality rates were referred in western countries.
Aim: Analyze morbidty and mortality rates after gastrectomy and D2 lymphadenectomy in western patients over twenty years.
Patients and Methods: Retrospective study of a Gastric Cancer Database (Department of Gastroenterology - University of Sao Paulo School of Medicine) from January 1985 to December 2005. Inclusion criteria were: patients with primary gastric adenocarcinoma arising in intact stomach that were submitted to gastrectomy and D2 Lymphadenectomy according to Japanese Gastric Cancer guidelines and UICC staging system.
Results: The review of our Database showed that 1522 patients had a diagnosis of gastric adenocarcinoma in the last twenty years. The resection rate was 74 %. Any type of gastrectomy was performed in 1093 cases. D2 lymphadenectomy was done in 795 cases (52 % of all patients). Median age was 62 years (range 21-93) and 498 (63%) patients were male. Median length of symptoms was 6 months (range 1-200). Tumors arising in lower third, Bormmann III lesions, and Nakamura undifferentiated type were the most common pathologic findings. Early Gastric cancer were diagnosed in 22% of the patients. Subtotal gastretomy was the main operation used. Roux-en-Y was done in 80 % of cases. Median hospital stay was 9 days (range 5 - 67). Blood transfusion was necessary in more than one third of patients. Median operating time was 360 minutes. Complications were observed in 23%. Total gastrectomy (p = 0,0001), lesions affecting the whole stomach (p = 0,004), age over 70 years (p = 0,001), and resection of others organs (p = 0,00001) were correlated with higher morbidity rates. Logistic regression analysis showed that resection of others organs (odds ratio = 2.6547) and ages over 70 years (odds ratio = 2.3371) were independent factors. Postoperative deaths occurred in 3.7 % of patients. Age over 70 years was correlated with higher mortality rate.
Conclusion: D2 lymphadenectomy is a safe procedure and could be done with low morbidity and mortality in a western population.