title: A meta-analysis of D1 versus D2 lymph node dissection.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Rajini
authors.initials: R
authors.lastname: Seevaratnam
authors.forename: Alina
authors.initials: A
authors.lastname: Bocicariu
authors.forename: Roberta
authors.initials: R
authors.lastname: Cardoso
authors.forename: Alyson
authors.initials: A
authors.lastname: Mahar
authors.forename: Alex
authors.initials: A
authors.lastname: Kiss
authors.forename: Lucy
authors.initials: L
authors.lastname: Helyer
authors.forename: Calvin
authors.initials: C
authors.lastname: Law
authors.forename: Natalie
authors.initials: N
authors.lastname: Coburn
mesh_terms: D017052:Hospital Mortality; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D010179:Pancreas / Q000473:pathology / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D013154:Spleen / Q000473:pathology / Q000601:surgery; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate