الفهرس 
I. INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Gastric cancer is one of the most common causes of death worldwide. Although the prognosis of patients with advanced gastric cancer has improved with the introduction of effective chemotherapy or adjuvant radiotherapy, surgical resection remains the primary therapeutic modality for curable advanced cancer. With regard to surgical procedure, dissection of regional LN is regarded an important part of en bloc resection for gastric cancer. However, there are significant differences in the extent of lymphadenectomy preformed by surgeons in different countries. In Japan, D2 dissection has been recommended as standard practice since the 1960s. East Asian surgeons, especially Japanese and Korean surgeons, routinely performed gastrectomy with D2 dissection. However, most Western surgeons perform gastrectomy with only D1 dissection, because D1 was associated with less mortality and morbidity than D2 in prospective randomized trials preformed in the Netherland and the UK, concluded that there was no survival benefit for D2 over D1 lymph node dissection. However, there were significant problems with these studies, including a high morbidity and mortality rate in the D2 group associated with inadequate surgical training, with inadequate dissection of D2 and with the frequent performance of distal pancreatectomy and splenectomy in the D2 group, which is now considered unnecessary. 210 More recent studies have demonstrated that western surgeons at experienced centers can be trained to perform D2 gastrectomy for selected western patients with low morbidity and mortality. There may be some benefits to D2 gastrectomy when performed safely, but this assertion requires further validation to establish the global standard in gastrectomy. This study was carried on 30 patients with operable gastric adenocarcinoma, subdivided into two groups as regards to surgical management, D1 gastrectomy group and D2 gastrectomy group. The mean age of the studied patients for D1 group was 56.53 years and for D2 group was 52.47 years. The main clinical presentations of the patients were vague upper gastrointestinal symptoms, dyspepsia, anemia and weight loss. After pathologic diagnosis by endoscopic biopsy and staging by CT scan, all patients were subjected to surgical treatment in the form of subtotal (distal or proximal) or total D1 or D2 gastrectomy. The resected specimens were examined for the size of the tumor, its type, depth of penetration (T stage) and histological grade. The resected lymph nodes were examined for their total number and number of involved nodes. 211 The tumor location was mainly in the lower and middle segments of the stomach. The mean tumor size was 62 mm. Distal subtotal gastrectomy (DSTG) was done in 13 patients in D1 group and in 10 patients in D2 group, proximal subtotal gastrectomy (PSTG) was done in one patient in D1 group and in 2 patients in D2 group, and total gastrectomy (TG) was done in one case in D1 group and in 3 cases in D2 group. Extended organ resections (splenectomy in 2 cases of D2 and in one case of D1 and left hepatectomy in one case of D1) were done. Reconstruction done in the form of Roux‐en‐Y gastrojejunostomy in 11 cases and Billroth II gastrojejunostomy in 15 cases of DSTG, and in PSTG esophagogastrostomy with gastric pull up in 2 cases and esophagogastric anastomosis with jejunal loop interposition in one case. All patients were followed up in the postoperative period for complications. The mean number of early postoperative complications was 33.3% for both D1 and D2 gastrectomy, and for late postoperative complications was 26.7% for D1 and 46.7% for D2, with no statistical significant difference. Complications increased the length of postoperative hospital stay. In this study, during the 2‐year follow up period, the recurrence after D1 was 40% and after D2 was 6.7% with statistically significant 212 difference. All cases of recurrence received chemo‐radio.