title: Personalized Surgery for Gastric Adenocarcinoma: A Meta-analysis of D1 versus D2 Lymphadenectomy.
abstract: BACKGROUND
  The recent publication of 5-year survival data for the Italian Gastric Cancer Study Group (IGCSG) D1 versus D2 lymphadenectomy for gastric cancer trial adds important data for analysis of whether a D2 lymphadenectomy improves survival.
  
  
  METHODS
  Systematic searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from January 1, 1985 to February 1, 2014. Meta-analyses were performed using RevMan version 5 software. Long-term outcomes were analyzed. Subgroup analyses of T and N stage were performed.
  
  
  RESULTS
  Outcomes of four randomized, controlled trials involving 1,599 patients (823 D1: 776 D2) enrolled from 1982 to 2005 were included for qualitative analysis and quantitative meta-analysis. Despite the addition of long-term survival data from the IGCSG, 5-year overall and nodal status survival was similar between D1 and D2 trials. However, subgroup analysis revealed a survival benefit for T3 patients (odds ratio 1.64, 95 % confidence interval 1.01-2.67) and a trend for survival benefit for advanced nodal stage (odds ratio 1.36, 95 % confidence interval 0.98-1.87) with D2 compared with D1 lymphadenectomy.
  
  
  CONCLUSIONS
  As recent studies have demonstrated comparable short-term surgical outcomes for both D1 and D2 lymphadenectomies, consideration should be made for more extensive lymph node dissection among patients with advanced stage.
authors.affiliation: Department of Surgery, St. Barnabas Medical Center, Livingston, NJ, USA.
authors.forename: Abraham
authors.initials: A
authors.lastname: El-Sedfy
authors.forename: Matthew
authors.initials: M
authors.lastname: Dixon
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 G
authors.initials: NG
authors.lastname: Coburn
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D057285:Precision Medicine; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*