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Ramírez-Giraldo C, Avendaño-Morales V, Van-Londoño I, Melo-Leal D, Camargo-Areyanes MI, Venegas-Sanabria LC, Vargas JPV, Aguirre-Salamanca EJ, Isaza-Restrepo A. Lymph Node Dissection of Choice in Older Adult Patients with Gastric Cancer: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:7678. [PMID: 39768601 PMCID: PMC11678213 DOI: 10.3390/jcm13247678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 10/27/2024] [Accepted: 10/28/2024] [Indexed: 01/11/2025] Open
Abstract
Background: Although the current literature has shown an increasing interest in surgical treatment of gastric cancer (GC) in older adults in recent years, there is still no consensus on proper management in this subgroup of patients. This study was designed with the objective of evaluating the current evidence that compares limited lymph node dissection with extended lymph node dissection in older adult patients (≥65 years) coursing with resectable GC. Methods: A systematic review of PubMed, Cochrane library, and ScienceDirect was performed according to PRISMA guidelines. All studies before 2018 were selected using a systematic review by Mogal et al. Studies were eligible for this meta-analysis if they were randomized controlled trials or non-randomized comparative studies comparing limited lymph node dissection versus extended lymph node dissection in patients with resectable GC taken to gastrectomy. Results: Seventeen studies and a total of 5056 patients were included. There were not any statistically significant differences in OS (HR = 1.04, CI95% = 0.72-1.51), RFS (HR = 0.92, CI95% = 0.62-1.38), or CSS (HR = 1.24, CI95% = 0.74-2.10) between older adult patients taken to limited and extended lymphadenectomy in addition to gastrectomy as the current surgical treatment for GC. Although a higher rate of major complications was observed in the extended lymphadenectomy group, this difference was not statistically significant in incidence between both groups of patients (OR = 1.92, CI95% = 0.75-4.91). Conclusions: Limited lymphadenectomy must be considered as the better recommendation for surgical treatment for GC in older adult patients, considering the oncological outcomes and lower rates of complications compared with more radical lymph node dissections.
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Affiliation(s)
- Camilo Ramírez-Giraldo
- Hospital Universitario Mayor-Méderi, Bogotá 111411, Colombia; (V.A.-M.); (L.C.V.-S.); (E.J.A.-S.); (A.I.-R.)
- Universidad del Rosario, Bogotá 111221, Colombia; (I.V.-L.); (D.M.-L.); (M.I.C.-A.); (J.P.V.V.)
| | - Violeta Avendaño-Morales
- Hospital Universitario Mayor-Méderi, Bogotá 111411, Colombia; (V.A.-M.); (L.C.V.-S.); (E.J.A.-S.); (A.I.-R.)
| | - Isabella Van-Londoño
- Universidad del Rosario, Bogotá 111221, Colombia; (I.V.-L.); (D.M.-L.); (M.I.C.-A.); (J.P.V.V.)
| | - Daniela Melo-Leal
- Universidad del Rosario, Bogotá 111221, Colombia; (I.V.-L.); (D.M.-L.); (M.I.C.-A.); (J.P.V.V.)
| | | | - Luis Carlos Venegas-Sanabria
- Hospital Universitario Mayor-Méderi, Bogotá 111411, Colombia; (V.A.-M.); (L.C.V.-S.); (E.J.A.-S.); (A.I.-R.)
- Universidad del Rosario, Bogotá 111221, Colombia; (I.V.-L.); (D.M.-L.); (M.I.C.-A.); (J.P.V.V.)
| | | | | | - Andrés Isaza-Restrepo
- Hospital Universitario Mayor-Méderi, Bogotá 111411, Colombia; (V.A.-M.); (L.C.V.-S.); (E.J.A.-S.); (A.I.-R.)
- Universidad del Rosario, Bogotá 111221, Colombia; (I.V.-L.); (D.M.-L.); (M.I.C.-A.); (J.P.V.V.)
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Lorenzon L, Giudicissi R, Scatizzi M, Balducci G, Cantafio S, Biondi A, Persiani R, Mercantini P, D'Ugo D. D1-plus vs D2 nodal dissection in gastric cancer: a propensity score matched comparison and review of published literature. BMC Surg 2020; 20:126. [PMID: 32522177 PMCID: PMC7285465 DOI: 10.1186/s12893-020-00714-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 03/13/2020] [Indexed: 12/23/2022] Open
Abstract
Background The results of D1-plus lymphadenectomy following gastric resection are seldom investigated. The aim of this study was to compare results of D1-plus vs D2 resections and to provide a literature review. Methods Patients who underwent upfront R0 gastrectomy for adenocarcinoma from 2000 to 2016 in three Institutions were selected using propensity scores and categorized according to lymphadenectomy. Statistical analyses were performed for the nodal harvest (LNH) and survival. Published literature comparing D1-plus and D2 was reviewed and analyzed according to PICO and PRISMA guidelines. Results Two matched groups of 93 D1-plus and 93 D2 resections were selected. LNH was significantly greater in D2 vs D1-plus dissections (mean 31.2 vs 27.2, p 0.04), however LNH distribution was similar. The cumulative incidence curves for overall survival, disease free and disease specific events did not report significant differences, however Cox regression analysis disclosed that total gastrectomies (HR 1.8; 95% 1.0–2.9), advanced stages (HR 5.9; 95% 3.4–10.3) and D1-plus nodal dissection (HR 2.1; 95% 1.26–3.50) independently correlated with disease free survival. Literature review including 297 D1-plus and 556 D2 lymphadenectomies documented LNH in favor of D2 sub-group (SMD -0.772; 95%CI -1.222- -0.322). Conclusion D2 provided greater LNH than D1-plus dissections; prospective studies should aim to investigate long-term survival of D1-plus lymphadenectomy.
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Affiliation(s)
- Laura Lorenzon
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Largo Francesco Vito 1, 00168, Rome, Italy.
| | - Rosina Giudicissi
- Department of General and Oncologic Surgery, Santo Stefano Hospital, Prato, Italy
| | - Marco Scatizzi
- Department of General and Oncologic Surgery, Santo Stefano Hospital, Prato, Italy
| | - Genoveffa Balducci
- Surgical and Medical Department of Traslational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, via di Grottarossa 1035, Rome, 00185, Italy
| | - Stefano Cantafio
- Department of General and Oncologic Surgery, Santo Stefano Hospital, Prato, Italy
| | - Alberto Biondi
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Roberto Persiani
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Paolo Mercantini
- Surgical and Medical Department of Traslational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, via di Grottarossa 1035, Rome, 00185, Italy
| | - Domenico D'Ugo
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Largo Francesco Vito 1, 00168, Rome, Italy
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