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PAND Doesn't Add to Survival With Gastric Cancer

Procedure with D2 lymphadenectomy in gastrectomy not recommended based on study

WEDNESDAY, July 30 (HealthDay News) -- In patients undergoing gastrectomy for curable gastric cancer, the addition of para-aortic nodal dissection (PAND) to D2 lymphadenectomy isn't advisable, according to research in the July 31 New England Journal of Medicine.

Mitsuru Sasako, M.D., of the National Cancer Center Hospital in Tokyo and colleagues analyzed data from 523 patients with curable stage T2b, T3 or T4 gastric cancer. Patients were randomized during surgery to receive D2 lymphadenectomy alone or with PAND. The primary end point was overall survival, defined as time from randomization to death.

Five-year overall survival was roughly 70 percent for both groups, with no significant difference. And there was no significant difference found between the groups in recurrence-free survival. Although the rates of surgery-related complications weren't significantly different, surgeries involving PAND were associated with longer median operation time (63 minutes longer) and greater median blood loss (230 milliliters greater).

"The clinical value of systematic PAND in addition to D2 gastrectomy in curable gastric cancer has been controversial," the authors write. "In conclusion, extended D2 lymphadenectomy plus PAND should not be used to treat curable stage T2b, T3, or T4 gastric cancer. D2 gastrectomy is associated with low mortality and reasonable survival times when performed in selected institutions that have had sufficient experience with the operation and with postoperative management."

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