Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma

Memon, Muhammed Ashraf and Subramanya, Manjunath S. and Khan, Shahjahan and Hossain, Md. Belal and Osland, Emma and Memon, Breda (2011) Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Annals of Surgery, 253 (5). pp. 900-911. ISSN 0003-4932


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.

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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: Permanent restricted access to published version due to publisher copyright policy.
Faculty/School / Institute/Centre: Historic - Faculty of Sciences - Department of Maths and Computing
Date Deposited: 03 Feb 2012 01:57
Last Modified: 02 May 2017 23:16
Uncontrolled Keywords: meta-analysis; D1 and D2 surgery; gastrectomy; gastric andenocarcinoma; randomised control trials
Fields of Research : 01 Mathematical Sciences > 0102 Applied Mathematics > 010202 Biological Mathematics
11 Medical and Health Sciences > 1103 Clinical Sciences > 110307 Gastroenterology and Hepatology
11 Medical and Health Sciences > 1103 Clinical Sciences > 110323 Surgery
Socio-Economic Objective: C Society > 92 Health > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920102 Cancer and Related Disorders
Identification Number or DOI: 10.1097/SLA.0b013e318212bff6

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