An Experience of Radical Gastrectomy in Indian Patients with Gastric Carcinoma

Radical gastrectomy with N2 lymphadenectomy (D2 gastrectomy) has been shown to have a survival advantage in Japanese and western trials, but Indian experience is limited. A retrospective analysis of prospectively collected data of patients with carcinoma of the stomach considered for surgery from 2009 to 2014. The operative details, pathological TNM stage and survival were analysed. Total number of patients was 58, out of which 34 patients (59%) had radical gastrectomy with N2 lymphadenectomy (D2-gastrectomy), 11 (18%) patients had locally advanced disease and 13 (22%) patients had metastatic disease. Mean blood loss was 180ml (+/- 85SD), and mean duration of surgery was 286 (+/- 65SD) minutes. Median length of hospital stay was 8days (6-17days), 30-day mortality was zero and a total of four patients (12%) had grades III to IV complications (Clavien-Dindo classification). The median number of lymph nodes removed was 18 (11-31). Pathological TNM stage was II in 8%, III in 47% and IV in 41%. The median survival of patients undergoing curative resection was 28months, and it was 6months in patients without curative resection (P<0.001). Radical gastrectomy (D2) may improve the survival of Indian patients with potentially curable gastric cancer; the outcome of surgery is dependent upon T stage and lymph node metastasis.