An evidence-based medicine review of lymphadenectomy extent for gastric cancer.
BACKGROUND
Several studies in the literature have investigated the possible role of the extent of lymphadenectomy in gastric cancer treatment failure. The current study attempted to determine the effectiveness and safety of lymphadenectomy with gastrectomy for the treatment of gastric cancer.


METHODS
Randomized controlled trials (RCTs) were identified by means of MEDLINE, EMBASE, Cochrane Controlled Trials Register databases, and Chinese Biomedical Database, as well as by selecting references from relevant articles.


RESULTS
Overall, 14 RCTs (3,432 patients) were included in the meta-analysis. Of the D1 and D2 surgery groups, the operative mortality and postoperative morbidity were higher in the D2 group than in the D1 group, but the 3- and 5-year survival rates were not statistically different. Also the operative time was shorter in D1 compared to D2. In the D2 versus the D3 surgical group, the operative mortality, percentage of postoperative complications, operative time, and hospital stay were not significantly different.


CONCLUSIONS
The results suggest that D2 and D3 surgery may not offer specific advantages for gastric cancer and instead may lead to disadvantages for patient outcomes.
Yang
Sun Hu
SH
Department of General Surgery, Lanzhou University Second Hospital, No 80 Cuiyingmen, Chengguan District, Lanzhou City, Gansu, China.
Zhang
You Cheng
YC
Yang
Ke Hu
KH
Li
You Ping
YP
He
Xiao Dong
XD
Tian
Jin Hui
JH
Lv
Ting Hong
TH
Hui
Ying Hua
YH
Sharma
Neel
N
D019317:Evidence-Based Medicine; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome