Randomized clinical trial comparing survival after D1 or D2 gastrectomy for gastric cancer

Degiuli, Maurizio; Sasako, Mitsuru; Ponti, Antonio; Vendrame, A.; Tomatis, Mariano; Mazza, Camille; Borasi, Andrea; Capussotti, Lorenzo; Fronda, G.; Morino, Mario

doi:10.1002/bjs.9345

Cited by 262 publications

(160 citation statements)

References 23 publications

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“…An essential condition is that good early postoperative results in terms of morbidity and mortality should be ensured. This is consistent with the reports of observational non-randomized studies from specialized centers (6)(7)(8)(9)18,(26)(27)(28).…”

Section: Lymphadenectomy For Advanced Formssupporting

confidence: 92%

“…The 15-year follow-up evaluation of the Dutch trial showed a trend to overall survival improvement in D2 group, although not statistically significant; if we could virtually exclude this initial gap, long-term survival difference may be much higher, probably statistically significant (11). In the Italian trial by Degiuli et al, better long-term outcome was observed in patients with N2 tumors treated by D2 dissection compared with D1; in such trial, postoperative mortality was overlapping in the D1 and D2 groups (27). Then, it is probable that D2 dissection, when performed in specialized, high-volume centers, could offer a longterm survival benefit if postoperative complications and mortality are not increased.…”

Section: Potential Improvement In Long-term Survivalmentioning

confidence: 81%

“…The correct procedure of extended lymphadenectomy requires specialized experience in gastro esophageal surgery with an appropriate learning curve; indeed, the complication and mortality rates reported in the specialized Western centers are limited, generally overlapping or slightly higher than those reported by the Japanese authors (6)(7)(8)(9)18,(26)(27)(28)42,43). Furthermore, it is particularly important to limit the use of splenopancreatic resection to only selected cases.…”

Section: Early Resultsmentioning

confidence: 99%

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Lymphadenectomy: state of the art

Marrelli

Franco

Iudici

et al. 2017

Transl. Gastroenterol. Hepatol.

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The extent of lymphadenectomy in gastric cancer (GC) surgery has been for long time a matter of debate. Randomized trials performed in the West reported worse results of D2 dissection, in terms of postoperative complications and long-term survival benefit, than Eastern series and observational studies from specialized Western centers. However, long-term re-evaluation of such trials and in depth-analysis of other experiences demonstrated the potential benefit of D2 in reducing the probability of cancer-related death and the safety of this procedure when avoiding unnecessary spleno-pancreatectomy and in centers with ad adequate surgical volume. Nowadays, the D2 is considered the standard treatment in most guidelines all over the world. More limited procedures (D1, D1 plus) may be adequate in selected cases, and more extended dissections (D2 plus) could be indicated in advanced forms with high risk of metastases to distant nodes, but in specialized centers or in the setting of clinical studies. The integration with neoadjuvant therapies and multimodality approach could offer a chance of cure in groups of patients with poor results when approached with standard treatment.

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Section: Lymphadenectomy For Advanced Formssupporting

confidence: 92%

Section: Potential Improvement In Long-term Survivalmentioning

confidence: 81%

Section: Early Resultsmentioning

confidence: 99%

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Lymphadenectomy: state of the art

Marrelli

Franco

Iudici

et al. 2017

Transl. Gastroenterol. Hepatol.

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“…Nonrandomized Asian series have demonstrated improved os with D2 lymphadenectomy, making it the standard of care in East Asia [40][41][42][43][44][45] . However, randomized Western studies and a meta-analysis of D1 compared with D2 lymphadenectomy failed to reproduce the os benefit observed in the retrospective Eastern studies [46][47][48][49] . In 1997, the Union for International Cancer Control and the American Joint Committee on Cancer, in the 5th edition of their staging manual, recommended that a minimum of 15 lymph nodes be assessed per patient 50 .…”

Section: Summary Of Evidencementioning

confidence: 94%

Report from the 17th Annual Western Canadian Gastrointestinal Cancer Consensus Conference; Edmonton, Alberta; 11–12 September 2015

et al. 2016

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The 17th annual Western Canadian Gastrointestinal Cancer Consensus Conference (wcgccc) was held in Edmonton, Alberta, 11-12 September 2015. The wcgccc is an interactive multidisciplinary conference attended by health care professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) who are involved in the care of patients with gastrointestinal cancer. Surgical, medical, and radiation oncologists; pathologists; radiologists; and allied health care professionals participated in presentation and discussion sessions for the purposes of developing the recommendations presented here. This consensus statement addresses current issues in the management of gastric cancer.

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“…In 2014 Degiuli et al published the results from a randomized clinical trial in which 267 patients submitted to D1 or D2 lymphadenectomy did not show a significant difference in survival (27). However, a closer look at the study reveals that numerous patients considered as D1 actually underwent a more extended lymphadenectomy, resulting in substantial uniformity between the two procedures.…”

Section: Recent Studiesmentioning

confidence: 99%

Historical assumptions of lymphadenectomy

Morgagni¹,

Tringali²,

Barba³

et al. 2016

Transl. Gastroenterol. Hepatol.

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The role of lymphadenectomy for the treatment of gastric cancer is still very much open to debate. Consequently, Japanese, European and American surgeons perform different typologies of lymphadenectomy because of the absence of randomized clinical trials confirming the superiority of extended lymphadenectomy over less invasive surgery. In Japan, D2 lymphadenectomy has been considered as the gold standard for advanced gastric carcinoma for many years. Although numerous European studies have been conducted in an attempt to find differences between D1 and D2 lymphadenectomy, none has succeeded to date. The decision to wait for results attesting to the fact that D2 guarantees a better outcome than D1 resulted in a long delay in the implementation of D2 as the gold standard treatment in Europe. In the U.S., the study by Macdonald et al.

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Randomized clinical trial comparing survival after D1 or D2 gastrectomy for gastric cancer

Abstract: ISRCTN11154654 (http://www.controlled-trials.com).

Cited by 262 publications

References 23 publications

Lymphadenectomy: state of the art

Lymphadenectomy: state of the art

Report from the 17th Annual Western Canadian Gastrointestinal Cancer Consensus Conference; Edmonton, Alberta; 11–12 September 2015

Historical assumptions of lymphadenectomy

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