[Clinical values of extended lymph node dissection for gastric cancer:a meta-analysis for D1 versus D2 gastrectomy].
OBJECTIVE
To evaluate the survival, complication and postoperative mortality after D(1) or D(2) lymph node dissection for gastric cancer.


METHODS
All the randomized clinical trials about nodal dissection for gastric cancer published within the last 20 years were collected. Quality assessment was done on each trial and relevant data were extracted from qualified trials. Meta-analysis was performed with the use of RevMan 4.2 (Cochrane) for statistic analysis.


RESULTS
Three hundred and ninety-four trials were yielded at the initial search. Four trials, recruited 1316 cases of gastric cancer in total, were included after quality assessment. Results of Meta-analysis showed that standard D(2) dissection could effectively improve patients' long-term survival [RR 1.35, 95%CI(1.12-1.62), NNT=9] as compared with D(1) dissection. If splenectomy (or pancreatico-splenectomy) was involved, D(2) dissection only improved the clinical outcome of T(3)-staged cases [RR 1.80,95%CI(1.03-3.15), NNT=13]. D(2) dissection produced higher rates of postoperative complication [RR 1.72,95%CI(1.46-2.03), NNT=6] and mortality [RR 2.12,95%CI(1.39-3.25), NNT=21] than D(1) dissection.


CONCLUSIONS
Standard D(2) dissection can increase the overall survival rate when compared with D(1) dissection. If splenectomy (or pancreatico-splenectomy) cases are involved,D(2) dissection can only improve the survival rate of T(3)-staged patients. D(2) dissection yields higher postoperative morbidity and mortality than D(1) dissection.
Wang
Xue-fei
XF
Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Sun
Yi-hong
YH
Liang
De-ji
DJ
Wang
Cong
C
Fang
Yong
Y
Liu
Tian-shu
TS
Qin
Xin-yu
XY
D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D013274:Stomach Neoplasms / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome