Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, 71140Shanghai Jiao Tong University, China.
Department of Anorectal Surgery, Gansu Provincial Hospital, China.
Surg Innov. 2022 Jun;29(3):416-425. doi: 10.1177/15533506211060230. Epub 2022 Feb 1.
D3 lymphadenectomy for right colon cancer improves oncological outcomes. This meta-analysis aimed to compare operation data, histopathological characteristics, perioperative conditions, and long-term survival after D3 and D2 lymphadenectomy in right hemicolectomy.
We searched PubMed, Embase, and the Cochrane Library for relevant articles (up to March 31, 2020). Random-effects and fixed-effects meta-analysis models were used. Review Manager (RevMan) version 5.3 and Stata version 15.1 were used for pooled estimates.
After screening 714 articles, 7 articles with a total of 1368 patients were eligible for inclusion. Compared with D2, D3 lymphadenectomy improves results in terms of blood loss (weighted mean difference [WMD] = -20.63, 95% confidence interval [CI] -28.19 to -13.16, < .01), harvested lymph nodes (WMD = 8.86, 95% CI 7.74 to 9.98, < .01), 3-year overall survival (OS) (hazard ratio [HR] = 2.03, 95% CI 1.20 to 3.43, < .01), 5-year OS (HR = 2.22, 95% CI 1.15 to 4.30, = .02), and 5-year disease-free survival (DFS) (HR = 2.16, 95% CI 1.19 to 3.90, = .01). There was no significant difference regarding operation time, anastomosis leakage, wound infection, overall morbidity, postoperative hospital stay, mortality, length of dissected colon, and 3-year DFS ( >= .05).
It is suggested in this review that D3 lymphadenectomy is superior to D2 lymphadenectomy in terms of blood loss, harvested lymph nodes, 3-year OS, 5-year OS, and 5-year DFS. The conclusion must be drawn with caution due to the limited number of included studies. Further RCTs are needed for stronger evidence.
右半结肠癌行 D3 淋巴结清扫可改善肿瘤学结局。本荟萃分析旨在比较右半结肠切除术行 D3 和 D2 淋巴结清扫术的手术资料、组织病理学特征、围手术期情况及长期生存情况。
检索 PubMed、Embase 和 Cochrane Library 相关文献（截至 2020 年 3 月 31 日）。采用随机效应和固定效应模型进行荟萃分析。使用 Review Manager（RevMan）版本 5.3 和 Stata 版本 15.1 进行汇总估计。
经过筛选 714 篇文章，有 7 篇文章共 1368 例患者符合纳入标准。与 D2 相比，D3 淋巴结清扫术在出血量（加权均数差[WMD] = -20.63，95%置信区间[CI] -28.19 至 -13.16，<0.01）、清扫淋巴结数量（WMD = 8.86，95%CI 7.74 至 9.98，<0.01）、3 年总生存（OS）（风险比[HR] = 2.03，95%CI 1.20 至 3.43，<0.01）、5 年 OS（HR = 2.22，95%CI 1.15 至 4.30，=0.02）和 5 年无病生存（DFS）（HR = 2.16，95%CI 1.19 至 3.90，=0.01）方面更具优势。手术时间、吻合口漏、伤口感染、总发病率、术后住院时间、死亡率、切除结肠长度和 3 年 DFS 方面无显著差异（>=0.05）。
本综述认为，D3 淋巴结清扫术在出血量、清扫淋巴结数量、3 年 OS、5 年 OS 和 5 年 DFS 方面优于 D2 淋巴结清扫术。但由于纳入研究数量有限，该结论必须谨慎得出。需要进一步的 RCT 来提供更强有力的证据。
