A Clinical Trial of D1+ Versus D2 Distal Gastrectomy for Stage IB & II Advanced Gastric Cancer

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■ Background of Hypothesis A. JCOG (Japanese Clinical Oncology Group) 9501 Study : Addition of aorta lymph node dissection to D2 lymph node dissection does not increase survival rate. Wide range of operation is not always the best treatment. If invasion rate can be kept as minimal as possible while ...

■ Background of Hypothesis A. JCOG (Japanese Clinical Oncology Group) 9501 Study : Addition of aorta lymph node dissection to D2 lymph node dissection does not increase survival rate. Wide range of operation is not always the best treatment. If invasion rate can be kept as minimal as possible while maintaining survival rate, it can lead to more secure operation while also reducing the frequency of complication after the surgery. 20 It may be advantageous for patients in terms of operation time, cost, and quality of life. B. COACT 1001 study A previous study which compared the feasibility of lymph node dissection in open surgery and lapraroscopic surgery for advanced gastric cancer. 11p, 12a lymph node (D2) resection rate: 79.2% and 88.8% respectively in all advance gastric cancer. 11p, 12a lymph node (D2) metastasis rate: 1.9% and 2.9% respectively. Subgroup analysis 11p, 12a lymph node resection in cStage IB/IIA: 74.5-80.0% and 86.7-96.1% respectively. : 0% metastasis rate for both. lymph node dissection in cStage IIB/IIIA: 81.1-82.3% and 87.5-89.2% respectively.: metastasis rates are 2.1% and 2.4-12.1% respectively. Application: 11p and 12a lymph nodes, which belong in D2 lymph nodes, need to be resected in advance gastric cancer in IIB stage or higher. However, in earlier stages of advance gastric cancer, the probability of metastasis is very low; therefore, resection of D1+ lymph nodes, excluding 11p and 12a, is enough.

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