Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma

Memon, Muhammed Ashraf, Subramanya, Manjunath S., Khan, Shahjahan, Hossain, Md Belal, Osland, Emma and Memon, Breda (2011) Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Annals of Surgery, 253 5: 900-911. doi:10.1097/SLA.0b013e318212bff6

Author Memon, Muhammed Ashraf
Subramanya, Manjunath S.
Khan, Shahjahan
Hossain, Md Belal
Osland, Emma
Memon, Breda
Title Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma
Journal name Annals of Surgery   Check publisher's open access policy
ISSN 0003-4932
Publication date 2011-01-01
Year available 2011
Sub-type Article (original research)
DOI 10.1097/SLA.0b013e318212bff6
Open Access Status Not Open Access
Volume 253
Issue 5
Start page 900
End page 911
Total pages 12
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Formatted abstract
Objectives: To conduct a meta-analysis of randomized controlled trials evaluating the efficacy and drawbacks of limited (D1) versus extended lymphadenectomy (D2) for proven gastric adenocarcinoma.

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 of D1 versus D2 gastrectomy for gastric adenocarcinoma. The meta-analysis was prepared in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses statement. The 6 outcome variables analyzed included length of hospital stay; overall complication rate; anastomotic leak rate; reoperation rate; 30-day mortality rate and 5-year survival rate. Random effects meta-analyses were performed using odds ratios (OR) and weighted mean differences (WMD).

Results: Six trials totaling 1876 patients (D1 = 946, D2 = 930) were analyzed. In 5 of the 6 outcomes the summary point estimates favored D1 over D2 group with a statistically significant reduction of (i) 6.37 days reduction in hospital stay (WMD -6.37, confidence interval [CI] -10.66, -2.08, P = 0.0036); (ii) 58% reduction in relative odds of developing postoperative complications (OR 0.42, CI 0.27, 0.66, P = 0.0002); (iii) 60% reduction in anastomotic breakdown (OR 0.40, CI 0.25, 0.63, P = 0.0001); (iv) 67% reduction in reoperation rate (OR 0.33, CI 0.15, 0.72, P = 0.006); and (v) 41% reduction in 30-day mortality rate (OR 0.59, CI 0.40, 0.85, P = 0.0054). Lastly there was no significant difference in the 5-year survival (OR 0.97, CI 0.78, 1.20, P = 0.7662) between D1 and D2 gastrectomy patients.

Conclusions: On the basis of this meta-analysis we conclude that D1 gastrectomy is associated with significant fewer anastomotic leaks, postoperative complication rate, reoperation rate, decreased length of hospital stay and 30-day mortality rate. Finally, the 5-year survival in D1 gastrectomy patients was similar to the D2 cohort.
Keyword Surgery
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Human Movement and Nutrition Sciences Publications
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