title: Systematic review and meta-analysis of the effectiveness and safety of extended lymphadenectomy in patients with resectable gastric cancer.
abstract: BACKGROUND
  The extent of lymphadenectomy in the treatment of gastric cancer has been debated for more than two decades. This meta-analysis sought to evaluate the effectiveness and safety of extended lymphadenectomy in patients with gastric cancer.
  
  
  METHODS
  A comprehensive search was performed to identify randomized clinical trials (RCTs) comparing the outcomes of D1 and D2 dissection for gastric cancer in PubMed, EMBASE, the Cochrane Library, Science Citation Index, Web of Science and the Chinese Biomedical Literature Database in any language from inception of the database to March 2012. Meta-analyses were performed using Review Manager software.
  
  
  RESULTS
  Eight RCTs including a total of 2044 patients (D1, 1042; D2, 1002) were eligible for meta-analysis. Five-year survival and haemorrhage rates were similar in the two groups. There were significant differences in morbidity, anastomotic leakage, pancreatic leakage, reoperation rates, wound infection, pulmonary complications and postoperative mortality, all of which favoured D1 dissection. Subgroup analysis indicated a trend towards lower gastric cancer-related mortality in patients undergoing D2 dissection who did not also have resection of the spleen or pancreas.
  
  
  CONCLUSIONS
  D2 dissection was associated with a significantly higher postoperative risk. A trend towards lower gastric cancer-related mortality was found following D2 dissection that did not include resection of the spleen or pancreas, but further long-term survival data are needed to determine whether there is a specific survival benefit after D2 dissection.
authors.affiliation: The First Hospital of Lanzhou University, Lanzhou, China; Evidence-based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
authors.forename: L
authors.initials: L
authors.lastname: Jiang
authors.forename: K H
authors.initials: KH
authors.lastname: Yang
authors.forename: Y
authors.initials: Y
authors.lastname: Chen
authors.forename: Q L
authors.initials: QL
authors.lastname: Guan
authors.forename: P
authors.initials: P
authors.lastname: Zhao
authors.forename: J H
authors.initials: JH
authors.lastname: Tian
authors.forename: Q
authors.initials: Q
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D015588:Observer Variation; D010179:Pancreas / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation / Q000706:statistics & numerical data; D013154:Spleen / Q000601:surgery; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult