Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma
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Objectives: To conduct a meta-analysis of randomized controlled trials evaluating the relative merits of limited (D1) versus extended lymphadenectomy (D2) for proven gastric adenocarcinoma.
Data Sources and Review Methods: A search of Cochrane, Medline, PubMed, Embase, Science Citation Index and Current Contents electronic databases identified randomized controlled trials published in the English language between 1980 and 2008 comparing the outcomes D1 vs D2 gastrectomy for gastric adenocarcinoma. The meta-analysis was prepared in accordance with the Quality of Reporting of Meta-analyses (QUOROM) statement. The six outcome variables analysed included length of hospital stay; overall complication rate; anastomotic leak rate; re- operation rate; 30 day mortality rate and 5 year survival rate. Random effects meta-analyses were performed using odds ratios and weighted mean differences.
Results: Six trials totalling 1876 patients (D1=946, D2=930) were analyzed. In five out of the six outcomes the summary point estimates favoured D1 over D2 group with a statistically significant reduction of (i) 7.12 days reduction in hospital stay (WMD -7.12, CI -12.90, -1.35, 141p=0.0001); (ii) 58% reduction in relative odds of developing postoperative complications (OR 0.42, CI 0.24, 0.71, p=0.0014); (iii) 59% reduction in anastomotic breakdown (OR 0.41, CI 0.26, 0.65, p=0.0002); 67% reduction in re-operation rate (OR 0.33, CI 0.15, 0.72, p=0.006) and 42% reduction in 30 day mortality rate (OR 0.58, CI 0.4, 0.85, p=0.0052). Lastly there was no significant difference in the 5 year survival (OR 0.97, CI 0.78, 1.20, p=0.76) between D1 and D2 gastrectomy patients.
Conclusions: Based on this meta-analysis, D1 gastrectomy is associated with significant fewer anastomotic leaks, postoperative complication rate, reoperation rate, decreased length of hospital stay and 30 day mortality rate. Lastly the five year survival in D1 gastrectomy patients was similar to the D2 cohort.
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