Long-Term Impact of D2 Lymphadenectomy during Gastrectomy for Cancer: Individual Patient Data Meta-Analysis and Restricted Mean Survival Time Estimation

Abstract

Background: Debate exists concerning the impact of D2 vs. D1 lymphadenectomy on long-term oncological outcomes after gastrectomy for cancer. Methods: PubMed, MEDLINE, Scopus, and Web of Science were searched and randomized controlled trials (RCTs) analyzing the effect of D2 vs. D1 on survival were included. Overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) were assessed. Restricted mean survival time difference (RMSTD) and 95% confidence intervals (CI) were used as effect size measures. Results: Five RCTs (1653 patients) were included. Overall, 805 (48.7%) underwent D2 lymphadenectomy. The RMSTD OS analysis shows that at 60-month follow-up, D2 patients lived 1.8 months (95% CI −4.2, 0.7; p = 0.14) longer on average compared to D1 patients. Similarly, 60-month CSS (1.2 months, 95% CI −3.9, 5.7; p = 0.72) and DFS (0.8 months, 95% CI −1.7, 3.4; p = 0.53) tended to be improved for D2 vs. D1 lymphadenectomy. Conclusions: Compared to D1, D2 lymphadenectomy is associated with a clinical trend toward improved OS, CSS, and DFS at 60-month follow-up.

Short-Term Outcomes Analysis Comparing Open, Laparoscopic, Laparoscopic-Assisted, and Robotic Distal Gastrectomy for Locally Advanced Gastric Cancer: A Randomized Trials Network Analysis

“…D2 lymphadenectomy for gastric cancer is a matter of debate [59,65]. Lymph node metastasis has been shown to be a principal prognostic factor, while adequate lymphadenectomy is essential for accurate pathologic staging.…”

“…As D2 lymphadenectomy is time-consuming and technically demanding, concerns exist that more extended dissections may correlate with higher morbidity, especially in patients who underwent neoadjuvant treatment [70]. In locally AGC, pancreas and spleen preserving D2 lymphadenectomy is advocated as the gold standard approach; however, its role in survival improvement remains controversial [65]. The 8th AJCC edition endorses at least 15 lymph nodes for a correct and reliable N-staging, while in other studies, more extended dissections seem associated with a survival improvement [71].…”

Prognostic Relevance of Preoperative Immune, Inflammatory, and Nutritional Biomarkers in Patients Undergoing Gastrectomy for Resectable Gastric Adenocarcinoma: An Observational Multicentre Study

“…Gastric cancer is one of the most common malignancies worldwide, with few improvements in overall long-term results in recent decades [ 1 , 2 , 3 ]. Surgery remains the main treatment in candidates for curative intent, but perioperative adjuvant treatment has been shown to improve survival in patients with non-metastatic locally advanced tumours [ 4 ].…”