Personalized Surgery for Gastric Adenocarcinoma: A Meta-analysis of D1 versus D2 Lymphadenectomy

Abraham El-Sedfy, Matthew Dixon, Rajini Seevaratnam, Alina Bocicariu, Roberta Cardoso, Alyson Mahar, Alex Kiss, Lucy Helyer, Calvin Law, Natalie G. Coburn

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1820-1827
Number of pages8
JournalAnnals of Surgical Oncology
Issue number6
StatePublished - Jun 1 2015

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology


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