A Prospective Study of Early Postoperative Course and Pathological Outcome of Modified D2 Gastrectomy.
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 4
Abstract
Surgery still today remains an important modality of management for resectable cancer stomach, recent NCCN guideline recommends gastrectomy with D1 or modified D2 lymphnode dissection with a goal of examining 15 or more lymph nodes for localised resectable gastric cancer. Modified D2 dissection remains a widely practised surgical procedure for cancer stomach. In our institution we spare routine removal of lymphnodes around distal splenic arery, splenic hilum as well as pancreaticosplenectomy as a modification over standard D2 dissection. However the question remains whether the goal of examining the required number of lymph nodes is met irrespective of variables like age obesity, stage of disease, grade of tumour in this form of modified D2 lymphadenectomy . Secondly how the variables affect the yield of lymph nodes in pathological specimen of cancer stomach remains to be seen.Study group includes 40 cases of carcinoma stomach undergone modified D2 gasrectomy. Various parameters like age,sex,BMI,stage of disease,grade of tumour,site of tumour,patients’physiological profile, no. of lymph nodes yield were noted down. During postop period mostly complications like paralytic ileus, prolonged drainage, bile leak, chest infection, wound infection, thrombophlebitis, fever, pneumothorax were encountered.Among these prolong paralytic ileus, prolonged drainage, bile leak, chest infections were found to be most important morbidity factors. There was no mortality in the study because of better patient physiologic profile,proper postop management by providing enteral nutrition as early as possible as well as complete avoidance of pancreaticosplenectomy in most cases .The mean number of lymph nodes retrieved was 23.52±6.95 . Though lymph node dissection is less extensive in this modified method in comparison to classical D2 dissection the average lymph node yield is well above 16 which is set minimum by NCCN panel for proper surgical staging.Modified D2 gastrectomy is recommended as a procedure in cancer stomach where there is a need for lymphnode dissection apart from early gastric cancer. Proper D2 gastrectomy with pancreaticosplenectomy should be done when there is direct involvement of the organs by the tumour or gross disease at splenic hilum .Properly performed modified D2 gastrectomy should have more than 16 lymphnodes on subsequent pathological examination of the surgical specimen.
Authors and Affiliations
Subrat Kumar Sahu, Ranjana Giri
Keywords
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- DOI 10.9790/0853-1704030106.
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