Implementation and Early Results of Extended Lymph Node Dissection for Gastric Cancer in a Non-Specialized Western Center

Background: The optimal degree of lymph node dissection for gastric cancer is still matter of debate. Particularly, there are serious doubts about the reproducibility of extended lymph node dissection in western surgical units, and no studies to date have investigated factors influencing early results (mortality, major morbidity and reoperation rates) during the learning curve. Methods: Univariate and multivariate analysis of 19 variables on a prospective series of 313 consecutive resections for gastric cancer performed by ten different surgeons. Endpoints were mortality, major morbidity and reoperation rates, calculated within 60 days form the operation. Results: Early results were all independently influenced by the presence of comorbidities alone. ASA status III-IV vs I-II determined a higher operative mortality rate (11.9% vs 0.5%; Odds Ratio 12.3; 95% c.i. 1.53 to 98.1; p .018), a higher major morbidity rate (39.7% vs 16.6%; Odds Ratio 2.71; 95% c.i. 1.51 to 4.88; p .0008) and a higher reoperation rate (9.5% vs 2.1%; Odds Ratio 4.81; 95% c.i. 1.51 to 15.3; p .008). Conclusions: Extended lymph node dissection can be safely implemented into the clinical practice of a non-dedicated western institution by providing adequate coaching from more expert surgeons. This implementation protocol led to acceptable rates of operative morbi-mortality, independently influenced only by the comorbidity status.