Evaluation of D4 Dissection for Gastric Cancer

Shigeru Takahashi, Hajime Tokuda, Hiroshi Matsushige, Atsushi Takenaka, Hiroshi Izumi, Koji Fujii, Makoto Kato, Osamu Ikawa

Department of Surgery, Kyoto Second Red Cross Hospital

In order to determine the indications for D4 dissection for gastric cancer, complications, postoperative body weight loss and survival rates were compared with those of conventional methods of dissection. In our study D4 dissection was performed in 239 cases, conventional D3 in 117 cases and D2 in 480 cases. In the patients treated with D4 dissection, complications were more frequent (21.8%), blood loss was greater, duration of operation was longer and the mortality rate was much higher (5.0%) than in those tresated with conventional dissection. There was no significant difference in postoperative body weight loss between those who underwent D2 and D4 dissection. On the other hand, the outcome of patients who underwent D4 dissection was most favorable in stage ll (78.4% at 5 years), IIIa (59.5%), IIIb (55.3%),IVa (50.5%) and IVb (11.8%). These mortality rates suggesthat D4 dissection is effective for the cases more advanced than stage IIIa.

Key words
D4 dissection for gastric cancer, complication of D4 dissection, prognosis according to mode of dissection

Reprint requests
Shigeru Takahashi Department of Surgery, Kyoto Second Red Cross Hospital Kamazadori Marutamachi, Kamigyoku, Kyoto, 602 JAPAN

Accepted
December 7, 1994

To read the PDF file you will need Abobe Reader installed on your computer.