Meta-Analysis of D1 Versus D2 Gastrectomy for Gastric Adenocarcinoma

Memon, Muhammed Ashraf; Subramanya, M. S.; Khan, Shahjahan; Hossain, Belal; Osland, Emma; Memon, Breda

doi:10.1097/sla.0b013e318212bff6

Cited by 112 publications

(73 citation statements)

References 57 publications

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“…Previous reviews and meta-analyses have tried to clarify the debate [19][20][21][22][23][24]. With the publications of the short-term outcomes of the most recent trial (IGCSG-R01) and the 15-year follow-up of the Dutch trial [8], both of which reveal favorable results for the D2 resection, we sought to perform an updated meta-analysis of all RCTs comparing D1 and D2 procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Our meta-analysis differs from those previously published as it includes the completed short-term results of the IGCSG-R01 trial. The recently published meta-analysis by Memon et al [23] only considered the interim analysis of the IGCSG-R01 trial [25]. Additionally, our meta-analysis does not include the D1 versus D3 trial reported by Robertson et al [26], which describes dissection around the celiac axis and para-aortic nodes as well as complete removal of the spleen and distal pancreas for D3 patients.…”

Section: Short-term Outcomesmentioning

confidence: 99%

“…Additionally, our meta-analysis does not include the D1 versus D3 trial reported by Robertson et al [26], which describes dissection around the celiac axis and para-aortic nodes as well as complete removal of the spleen and distal pancreas for D3 patients. This trial was combined with the other D1 versus D2 trials in the meta-analyses performed by Lustosa et al, Yang et al, and Memon et al [20,21,23], which clouds the issue of D1 versus D2 dissection. Most importantly, none of the earlier meta-analyses examined the considerable effect of advances in surgical techniques and perioperative care with time.…”

Section: Short-term Outcomesmentioning

confidence: 99%

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A meta-analysis of D1 versus D2 lymph node dissection

et al. 2011

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Background Surgery is the only curative treatment for patients with gastric cancer. However, the extent of lymph node dissection is still debated. Therefore, with the publication of newer trial results, we conducted an updated meta-analysis of D1 versus D2 randomized controlled trials comparing outcomes. Methods Systematic searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from January 1, 1985, to December 31, 2010. Meta-analyses were performed using RevMan v5 software. Both short-and long-term outcomes were analyzed. Subgroup analyses of T stage and spleen/pancreas resection versus preservation were performed. Results Outcomes of 5 randomized trials involving 1642 patients (845 D1, 797 D2) enrolled from 1982 to 2005 were included. Despite the addition of the more recent trials, overall hospital mortality and reoperation rates were still higher in D2 cases. Subgroup analysis of recent trials and spleen/pancreas preservation revealed no significant difference in hospital mortality between groups. Five-year overall survival was similar between D1 versus D2 trials. Sub-analysis by tumor depth and spleen/pancreas preservation detected trends for improved survival with D2 lymphadenectomy in T3/T4 patients and those with spleen/ pancreas preservation. Conclusion Earlier trials show that D2 dissections have higher operative mortality, while recent trials have similar rates. A trend of improved survival exists among D2 patients who did not undergo resection of the spleen or pancreas, as well as for patients with T3/T4 cancers.

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Section: Discussionmentioning

confidence: 99%

Section: Short-term Outcomesmentioning

confidence: 99%

Section: Short-term Outcomesmentioning

confidence: 99%

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A meta-analysis of D1 versus D2 lymph node dissection

et al. 2011

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“…Furthermore, some patients lose the opportunity of curative resection resulting from the aggressive nature of GC. Although chemoradiotherapy and targeted therapy have confirmed an improvement in host response rates, the cancer recurrences and metastases are frequently observed 2, 3, 4, 5, 6. The bacteria Helicobacter pylori ( H. pylori) is one of the major risk factors for GC development.…”

Section: Introductionmentioning

confidence: 99%

Role of Helicobacter pylori infection in cancer‐associated fibroblast‐induced epithelial‐mesenchymal transition in vitro

et al. 2018

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BackgroundMajor human gastrointestinal pathogen Helicobacter pylori (H. pylori) colonizes the gastric mucosa causing inflammation and severe complications including cancer, but the involvement of fibroblasts in the pathogenesis of these disorders in H. pylori‐infected stomach has been little studied. Normal stroma contains few fibroblasts, especially myofibroblasts. Their number rapidly increases in the reactive stroma surrounding inflammatory region and neoplastic tissue; however, the interaction between H. pylori and fibroblasts remains unknown. We determined the effect of coincubation of normal rat gastric fibroblasts with alive H. pylori (cagA+vacA+) and H. pylori (cagA−vacA−) strains on the differentiation of these fibroblasts into cells possessing characteristics of cancer‐associated fibroblasts (CAFs) able to induce epithelial‐mesenchymal transition (EMT) of normal rat gastric epithelial cells (RGM‐1).Materials and MethodsThe panel of CAFs markers mRNA was analyzed in H. pylori (cagA+vacA+)‐infected fibroblasts by RT‐PCR. After insert coculture of differentiated fibroblasts with RGM‐1 cells from 24 up to 48, 72, and 96 hours, the mRNA expression for EMT‐associated genes was analyzed by RT‐PCR.ResultsThe mRNA expression for CAFs markers was significantly increased after 72 hours of infection with H. pylori (cagA+vacA+) but not H. pylori (cagA−vacA−) strain. Following coculture with CAFs, RGM‐1 cells showed significant decrease in E‐cadherin mRNA, and the parallel increase in the expression of Twist and Snail transcription factors mRNA was observed along with the overexpression of mRNAs for TGFβR, HGFR, FGFR, N‐cadherin, vimentin, α‐SMA, VEGF, and integrin‐β1.Conclusion Helicobacter pylori (cagA+vacA+) strain induces differentiation of normal fibroblasts into CAFs, likely to initiate the EMT process in RGM‐1 epithelial cell line.

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“…Lymphadenectomy is considered essential for gastric cancer surgery; however, the extent of lymph node removal is still debated in the literature [1][2][3][4][5][6]. In Asia, extended lymph node dissection has long been the standard of care for patients with advanced gastric cancer [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

A systematic review of spleen and pancreas preservation in extended lymphadenectomy for gastric cancer

et al. 2011

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Background The overall prognosis and survival of patients with advanced gastric cancer are generally poor. Extended lymphadenectomy is recommended for patients with advanced gastric cancer; however, splenectomy and distal pancreatectomy performed with an extended lymph node dissection may be associated with increased morbidity and mortality. Method Electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1 January 1998 to 31 December 2009. Studies on gastric carcinoma investigating extended lymphadenectomy with splenectomy and/or pancreaticosplenectomy that reported data on surgical outcomes or survival were selected. Results Forty studies were included in this review. Decreased complication rates were demonstrated with spleen preservation in two prospective studies and three retrospective studies, and with pancreas preservation in five retrospective studies. No randomized controlled trial showed survival benefit or detriment for preservation of spleen or pancreas in extended lymphadenectomy. Improved survival was demonstrated with spleen preservation in two prospective and eight retrospective studies, and with pancreas preservation in one prospective and four retrospective studies. Conclusions Preservation of the spleen and pancreas during extended lymphadenectomy for gastric cancer decreases complications with no clear evidence of improvement or detriment to overall survival.

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Meta-Analysis of D1 Versus D2 Gastrectomy for Gastric Adenocarcinoma

Cited by 112 publications

References 57 publications

A meta-analysis of D1 versus D2 lymph node dissection

A meta-analysis of D1 versus D2 lymph node dissection

Role of Helicobacter pylori infection in cancer‐associated fibroblast‐induced epithelial‐mesenchymal transition in vitro

A systematic review of spleen and pancreas preservation in extended lymphadenectomy for gastric cancer

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