title: Survival and recurrence free benefits with different lymphadenectomy for resectable gastric cancer: a meta-analysis.
abstract: BACKGROUND
  The objective of the present meta-analysis was to estimate the magnitude of survival and recurrence free benefits from different lymphadenectomy in patients with resectable gastric cancer.
  
  
  METHODS
  A comprehensive search was performed for original studies published from their inception to 2012. Two reviewers independently assessed search results, methodological quality, and data extraction of included studies. Results regarding the overall survival (OS) and recurrence free survival (RFS) in the meta-analysis were expressed as hazard ratios (HR) with 95% confidence intervals (CI).
  
  
  RESULTS
  Twelve randomized control trials (RCTs) were eligible for final meta-analysis. There was not significant difference in OS between D1 and D2 lymphadenectomy (HR = 0.92, 95% CI: 0.77-1.10, P = 0.36), but subgroup analysis of patients without splenectomy and/or pancreatectomy has a trend for OS much more benefiting D2 compared to D1 patients. A significant RFS improvement was found in favor of D2 lymphadenectomy, sensitivity analysis also gives similar fixed effect estimates (HR = 0.68, 95% CI: 0.58-0.81, P = 0.84). There were no significant differences in OS and RFS between D2 group and D3 group (1 trial).
  
  
  CONCLUSIONS
  The present meta-analysis indicates that D2 lymphadenectomy with spleen and pancreas preservation offers the most survival benefit for patients with gastric cancer when done safety.
authors.affiliation: Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Jiang
authors.forename: Ke-Hu
authors.initials: KH
authors.lastname: Yang
authors.forename: Quan-Lin
authors.initials: QL
authors.lastname: Guan
authors.forename: Peng
authors.initials: P
authors.lastname: Zhao
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
authors.forename: Jin-Hui
authors.initials: JH
authors.lastname: Tian
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010180:Pancreatectomy; D016032:Randomized Controlled Trials as Topic; D013156:Splenectomy; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome