Lymphadenectomy in gastric cancer: Contentious issues

Table 2 Previously published randomized clinical trials addressing the extent of lymphadenectomy in gastric cancer

Ref.	Study period	Study groups	Median follow-up	Result	Conclusion
Cuschieri et al[14]	1986-1993	D1 = 200, D2 = 200	6.5 yr, overall	5-yr OS in D1 vs D2 - 35% vs 33%, (HR = 1.10, 95%CI: 0.87-1.39)	Classical Japanese D2 resection offers no survival advantage over D1 surgery
Songun et al[13]	1989-1993	D1 = 380, D2 = 331	15.2 yr, overall	5-yr OS D1 vs D2 - 21% vs 29%, (log-rank P = 0.34), subgroup analysis of patients without pancreatico-splenectomy, 15-yr OS in D1 vs D2 = 22% vs 35% (HR = 1.34, 95%CI: 1.09-1.65; log-rank P = 0.006)	Spleen preserving D2 resection should be recommended as the standard surgical approach to resectable gastric cancer
Degiuli et al[17]	1998-2006	D1 = 133, D2 = 134	6.7 yr, overall	5-yr OS in two arms D1 vs D2 - 66.5% vs 64.2%, (difference -2.3, 95%CI: -14.0 to 9.3; P = 0.695), 5-yr disease-specific survival in pathological tumour pT2-4 in two arms D1 vs D2 - 38% vs 59%; P = 0.055	No difference in overall 5-yr survival between D1 and D2 resection; D2 lymphadenectomy may be a better choice in patients with advanced disease and lymph node metastases
Wu et al[19]	1993-1999	D1 = 110, D3 = 111	94.5 mo, for survivors	5-yr OS in D1 vs D3 - 53.6% vs 59.5% difference between groups 5.9% (95%CI: -7.3 to 19.1), log-rank P = 0.041)	D3 dissection offers a survival benefit for patients with gastric cancer compared with D1 dissection
Sasako et al[21]	1995-2001	D2 = 260, D2 + PAND = 263	5.6 yr for D2 lymphadenectomy alone and 5.7 yr for D2 lymphadenectomy plus PAND 94.5 mo, for survivors	5-yr overall survival rate for D2 vs D2 + PAND -69.2% vs 70.3% HR for death 1.03 (95%CI: 0.77-1.37; P = 0.85)	No survival benefit with D2 lymphadenectomy plus PAND in curable gastric cancer as compared with D2 lymphadenectomy alone
Yonemura et al[22]	1995-2002	D2 = 135, D2 + PAND = 134	NS	5-yr overall survival rate for D2 vs D2 + PAND -52.6% vs 55.0% (χ2 = 0.064; P = 0.801)	Prophylactic D4 dissection is not recommended for patients with potentially curable advanced gastric cancer
Kulig et al[20]	1999-2003	D2 = 141, D2 + PAND = 134	Results awaited	Results awaited	Results awaited

D1: D1 lymphadenectomy; D2: D2 lymphadenectomy; OS: Overall survival; HR: Hazard ratio; PAND: Para-aortic node dissection.