Randomized clinical trial of morbidity after D1 and D3 surgery for gastric cancer

Abstract

Extended lymphadenectomy for gastric cancer is associated with more complications than limited lymphadectomy but this does not lead to significant mortality.

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

“…In all trials the patient was finally eligible to enter the trial when, in the staging laparotomy, the tumor could be excised and if a safe margin for radical subtotal or total gastrectomy could be obtained. Biopsies and frozen sections of enlarged lymph nodes were obtained in the staging laparotomy in 4 trials 3,4,14,15 . The analysis of the outcome All the surgeons involved in four included trials 3,4,14,15 were trained and supervised the procedures.…”

“…Biopsies and frozen sections of enlarged lymph nodes were obtained in the staging laparotomy in 4 trials 3,4,14,15 . The analysis of the outcome All the surgeons involved in four included trials 3,4,14,15 were trained and supervised the procedures. The quality control was well described in 4 trials 3,4,5,14 , in which the participating surgeons had been specially trained for D2 dissection and for supervising the technique and the extent of lymph-node dissection; after the operation, the perigastric tissue was divided into the proper lymph-node stations and the number and location of nodes were detected at pathological examination in accordance with the protocol guidelines 4 .…”

“…Three trials 12,13,14 were national multicenter studies from the Netherlands, UK and Italy respectively; two studies 5,15 were done at single institutions in China and Taiwan respectively.…”

“…Three of the selected trials compared D1 vs. D2 12,13,14 and two trials compared D1 vs. D3 5,15 . These studies involved 1549 patients, of whom 791 were allocated to the D1 surgical procedure, 617 to D2 and 141 to D3.…”

“…A systematic review was conducted by McCulloch et al 6 , in 2005, including randomized and non-randomized comparisons between D1 and D2 gastrectomy for primary treatment of gastric cancer. The meta-analysis was performed separately; 15 separate studies were selected, comprising two randomized trials, two non-randomized comparisons and 11 cohort studies reporting results from one technique only.…”