El-Sedfy Abraham, Dixon Matthew, Seevaratnam Rajini, Bocicariu Alina, Cardoso Roberta, Mahar Alyson, Kiss Alex, Helyer Lucy, Law Calvin, Coburn Natalie G
Department of Surgery, St. Barnabas Medical Center, Livingston, NJ, USA.
Ann Surg Oncol. 2015;22(6):1820-7. doi: 10.1245/s10434-014-4168-6. Epub 2014 Oct 28.
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.
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.
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.
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.
意大利胃癌研究组（IGCSG）开展的胃癌D1与D2淋巴结清扫术5年生存数据的近期发表，为分析D2淋巴结清扫术是否能提高生存率增添了重要数据。
使用Medline、Embase以及Cochrane对照试验中央注册库，对1985年1月1日至2014年2月1日期间的文献进行系统检索。使用RevMan 5版软件进行荟萃分析。分析长期结局。对T和N分期进行亚组分析。
纳入了四项随机对照试验的结果，这些试验共纳入了1982年至2005年期间的1599例患者（823例行D1淋巴结清扫术，776例行D2淋巴结清扫术），用于定性分析和定量荟萃分析。尽管增加了IGCSG的长期生存数据，但D1和D2试验的5年总生存率和淋巴结状态生存率相似。然而，亚组分析显示，与D1淋巴结清扫术相比，D2淋巴结清扫术使T3期患者有生存获益（优势比1.64，95%置信区间1.01 - 2.67），且晚期淋巴结分期有生存获益趋势（优势比1.36，95%置信区间0.98 - 1.87）。
由于近期研究表明D1和D2淋巴结清扫术的短期手术结局相当，对于晚期患者应考虑进行更广泛的淋巴结清扫。
