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A meta-analysis of D1 versus D2 lymph node dissection.

Rajini Seevaratnam1, Alina Bocicariu, Roberta Cardoso

  • 1Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.

Gastric Cancer : Official Journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association
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D2 lymphadenectomy for gastric cancer shows similar survival to D1 but with higher initial mortality. Recent data suggests D2 may improve survival in advanced cancers (T3/T4) and when spleen/pancreas are preserved.

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Area of Science:

  • Surgical Oncology
  • Gastrointestinal Surgery
  • Clinical Trials

Background:

  • Gastric cancer surgery relies on lymph node dissection extent, with D1 and D2 approaches debated.
  • Optimal lymphadenectomy strategy remains unclear, necessitating updated evidence.

Purpose of the Study:

  • To conduct an updated meta-analysis of D1 versus D2 lymphadenectomy in gastric cancer randomized controlled trials.
  • To compare short- and long-term outcomes, including mortality and survival rates.

Main Methods:

  • Systematic literature searches of Medline, Embase, and Cochrane Central Register (1985-2010).
  • Meta-analysis of 5 randomized controlled trials (1642 patients) using RevMan v5.
  • Subgroup analyses based on T stage and spleen/pancreas resection status.

Main Results:

  • D2 lymphadenectomy was associated with higher initial hospital mortality and reoperation rates compared to D1.
  • No significant difference in hospital mortality was observed in recent trials or when spleen/pancreas were preserved.
  • Five-year overall survival rates were similar between D1 and D2 groups.
  • Trends suggested improved survival with D2 in T3/T4 tumors and spleen/pancreas preservation.

Conclusions:

  • While earlier D2 dissections showed higher operative mortality, recent trials indicate similar rates to D1.
  • A survival benefit trend for D2 lymphadenectomy is noted in advanced gastric cancers (T3/T4) and when spleen/pancreas are preserved.