Impact of extended lymphadenectomy on morbidity, mortality, recurrence and 5-year survival after gastrectomy for cancer: meta-analysis of randomized clinical trials

Lustosa, Suzana Angélica Silva; Saconato, Humberto; Atallah, Álvaro Nagib; Filho, Gaspar de Jesus Lopes; Matos, Délcio

doi:10.1590/s0102-86502008000600009

Cited by 24 publications

(18 citation statements)

References 31 publications

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“…Despite recent improvements in experimental and clinical oncology, about 70% of GC patients are firstly diagnosed at late stages with locally advanced or metastatic disease [36], and D2 lymphadenectomy has been widely used in Asia [37]. Lustosa et al reported that D2 or D3 lymphadenectomy showed lower incidence of recurrence and lower mortality with recurrent disease compared to D1 lymph node dissection [36].…”

Section: Discussionmentioning

confidence: 99%

“…Lustosa et al reported that D2 or D3 lymphadenectomy showed lower incidence of recurrence and lower mortality with recurrent disease compared to D1 lymph node dissection [36]. Degiuli et al compared D2 and D1 lymphadenectomy in the treatment of GC and showed a 5-year disease-specific survival benefit for patients with pT2-4 status and positive lymph nodes in the D2 group [38].…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic and Prognostic Value of Serum MicroRNA-206 in Patients with Gastric Cancer

Hou

Luo

2016

Cell Physiol Biochem

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Aims: Recent studies have demonstrated that microRNAs (miRNAs) can serve as useful biomarkers for human cancers. The aim of this study was to evaluate the expression level of serum miRNA-206 in patients with gastric cancer (GC) and investigate its diagnostic and prognostic value. Methods: Quantitative real-time PCR was performed to evaluate serum miRNA-206 levels in 150 GC patients and 150 healthy volunteers. The association between miRNA-206 expression and clinicopathological factors as well as patient's survival was analyzed. Receiver operator curve (ROC) analysis was carried out to assess the potential value of serum miRNA-206 for GC diagnosis. Results: Serum miRNA-206 was down-regulated in GC patients compared with healthy controls (P < 0.001). Decreased serum miRNA-206 expression was significantly associated with deep local invasion, positive lymph node metastasis, and advanced clinical stage. Serum miRNA-206 expression was found to be significantly up-regulated in paired post-operative samples and reduced in patients with GC recurrence. ROC curve analysis showed that serum miRNA-206 was a useful marker for GC diagnosis, and could discriminate between recurred and non-recurred patients. Multivariate Cox regression analysis confirmed low serum miRNA-206 expression as an independent unfavorable prognostic factor for both DFS and OS of GC patients. Conclusions: These results suggest that serum miRNA-206 might not only serve as a novel diagnostic biomarker for GC, but also predict cancer recurrence and patient's prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnostic and Prognostic Value of Serum MicroRNA-206 in Patients with Gastric Cancer

Hou

Luo

2016

Cell Physiol Biochem

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“…Previous reviews and meta-analyses have tried to clarify the debate [19][20][21][22][23][24]. With the publications of the short-term outcomes of the most recent trial (IGCSG-R01) and the 15-year follow-up of the Dutch trial [8], both of which reveal favorable results for the D2 resection, we sought to perform an updated meta-analysis of all RCTs comparing D1 and D2 procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, our meta-analysis does not include the D1 versus D3 trial reported by Robertson et al [26], which describes dissection around the celiac axis and para-aortic nodes as well as complete removal of the spleen and distal pancreas for D3 patients. This trial was combined with the other D1 versus D2 trials in the meta-analyses performed by Lustosa et al, Yang et al, and Memon et al [20,21,23], which clouds the issue of D1 versus D2 dissection. Most importantly, none of the earlier meta-analyses examined the considerable effect of advances in surgical techniques and perioperative care with time.…”

Section: Short-term Outcomesmentioning

confidence: 99%

A meta-analysis of D1 versus D2 lymph node dissection

et al. 2011

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Background Surgery is the only curative treatment for patients with gastric cancer. However, the extent of lymph node dissection is still debated. Therefore, with the publication of newer trial results, we conducted an updated meta-analysis of D1 versus D2 randomized controlled trials comparing outcomes. Methods Systematic searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from January 1, 1985, to December 31, 2010. Meta-analyses were performed using RevMan v5 software. Both short-and long-term outcomes were analyzed. Subgroup analyses of T stage and spleen/pancreas resection versus preservation were performed. Results Outcomes of 5 randomized trials involving 1642 patients (845 D1, 797 D2) enrolled from 1982 to 2005 were included. Despite the addition of the more recent trials, overall hospital mortality and reoperation rates were still higher in D2 cases. Subgroup analysis of recent trials and spleen/pancreas preservation revealed no significant difference in hospital mortality between groups. Five-year overall survival was similar between D1 versus D2 trials. Sub-analysis by tumor depth and spleen/pancreas preservation detected trends for improved survival with D2 lymphadenectomy in T3/T4 patients and those with spleen/ pancreas preservation. Conclusion Earlier trials show that D2 dissections have higher operative mortality, while recent trials have similar rates. A trend of improved survival exists among D2 patients who did not undergo resection of the spleen or pancreas, as well as for patients with T3/T4 cancers.

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“…Of these 129 patients, 15 died of recurrence, 6 died of surgical complications, and 108 died of diseases other than the primary gastric cancer. In a recent meta-analysis of randomized clinical trials, Lustosa et al [33] reported that overall, in 642 D2/D3 versus 690 D1 patients, a signifi cantly higher recurrence rate was found in the D1 lymphadenectomy group (RR, 0.89; 95% CI: 0.80 to 0.98, P < 0.02) with significant statistical data heterogeneity (P = 0.03 and I 2 = 71%) in the 3 randomized clinical trials analyzed [19,34,35] .…”

Section: D2 Lymphadenectomy Is An Imperative Procedures For the Contromentioning

confidence: 99%

D2 lymphadenectomy in gastric cancer surgery

Deng¹,

Liang²

2009

Clin. Oncol. Cancer Res.

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Gastric cancer is one of the most common causes of cancer death worldwide. Surgery is the most widely utilized treatment for resectable gastric cancer. Evidence indicates that lymph node involvement and depth of invasion of the primary tumor are the most important prognostic factors for gastric cancer patients. Therefore, lymph node clearance is deemed a key procedure in gastric cancer surgery for the prognostic value to patients. Although the appropriate lymphadenectomy during gastrectomy for cancer still remains controversial, extended lymph node dissection (D2 lymphadenectomy) should be recommended in high volume hospitals.

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Impact of extended lymphadenectomy on morbidity, mortality, recurrence and 5-year survival after gastrectomy for cancer: meta-analysis of randomized clinical trials

Cited by 24 publications

References 31 publications

Diagnostic and Prognostic Value of Serum MicroRNA-206 in Patients with Gastric Cancer

Diagnostic and Prognostic Value of Serum MicroRNA-206 in Patients with Gastric Cancer

A meta-analysis of D1 versus D2 lymph node dissection

D2 lymphadenectomy in gastric cancer surgery

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