This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Gastrectomy with extended lymphadenectomy for primary treatment of gastric cancer. BJS 2005; 92: 5-13.
Published: 5th January 2005
Authors: P. McCulloch, M. Eidi Niita, H. Kazi, J. J. Gama‐Rodrigues
Background
The appropriate extent of lymph node clearance during gastrectomy for cancer remains controversial.
Method
Medline, Embase, the Cochrane register and other databases were searched for studies reporting node dissection technique, 5 year survival and mortality after gastrectomy. Comparisons with systematic bias in treatment allocation and patients who received perioperative chemotherapy were excluded. Meta‐analysis was performed separately for randomized and non‐randomized comparisons.
Results
Two randomized and two non‐randomized comparisons of limited (D1) versus extended (D2) node dissection and 11 reports of one dissection type were analysed. For D2 the randomised trials showed no overall survival benefit (Risk ratio (RR) = 0·95, 95 per cent c.i. 0·83–1·09) and an increased postoperative mortality (RR = 2·23, c.i. 1·45–3·45), apparently related to pancreatico‐splenectomy and surgical inexperience. A trend towards survival benefit for D2 was observed for T3+ tumours (RR = 0·68, c.i. 0·42–1·10). Non‐randomized comparisons found no survival benefit for D2 (RR = 0·92, c.i. 0·83–1·02), but decreased postoperative mortality (RR = 0·65, c.i. 0·45–0·93). Nine observational studies of D2 reported better results than two studies of D1 surgery, but in very different settings.