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The recent publication of 5-year survival data for the Italian Gastric Cancer Study Group (IGCSG) D1 versus D2 lymphadenectomy for gastric cancer trial adds important data for analysis of whether a D2 lymphadenectomy improves survival. Systematic searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from January 1, 1985 to February 1, 2014. Meta-analyses were performed using RevMan version 5 software. Long-term outcomes were analyzed. Subgroup analyses of T and N stage were performed. Outcomes of four randomized, controlled trials involving 1,599 patients (823 D1: 776 D2) enrolled from 1982 to 2005 were included for qualitative analysis and quantitative meta-analysis. Despite the addition of long-term survival data from the IGCSG, 5-year overall and nodal status survival was similar between D1 and D2 trials. However, subgroup analysis revealed a survival benefit for T3 patients (odds ratio 1.64, 95 % confidence interval 1.01–2.67) and a trend for survival benefit for advanced nodal stage (odds ratio 1.36, 95 % confidence interval 0.98–1.87) with D2 compared with D1 lymphadenectomy. As recent studies have demonstrated comparable short-term surgical outcomes for both D1 and D2 lymphadenectomies, consideration should be made for more extensive lymph node dissection among patients with advanced stage.

The rapid evolution of gastric cancer treatment in the face of escalating costs mandates thorough cost-effectiveness analyses to optimally direct future research and decision making. Relative to other cancer sites, the literature lacks high-quality economic evaluations to supplement clinical efficacy and effectiveness studies. As the fourth most commonly diagnosed cancer and the third leading cause of cancer-related death [1], gastric cancer is a major clinical and financial burden. Yet, very few estimations and assessments of overall costs of existing treatment methods or evaluations of cost effectiveness have been performed and fewer still meet current standards of high-quality methodology. Existing reports are often far from transparent, and very few studies present their findings according to established guidelines for the reporting of health economic data [2]. Furthermore, the few studies that have examined the overall costs of a gastric cancer diagnosis and treatment have determined that it is one of the most expensive cancers to treat on a per-patient basis [3, 4]. In the last 30 years, fewer than 30 papers have been published in English attempting to assess the costs of a gastric cancer diagnosis or explicitly compare the costs and benefits of treatment alternatives. In comparison, using the MeSH heading ‘‘Costs and Cost Analysis’’ in MEDLINE, over 300 review articles are identified for breast cancer, over 300 review articles identified for colorectal cancer, and over 100 review articles for prostate cancer; thus indicating that enough primary literature exists to generate these numerous reviews. In addition to the scientific literature, rigorous health technology assessments for new drugs and technologies are more commonly performed by government regulatory bodies such as the National Institute for Health and Care Excellence (NICE) and published as peer-reviewed reports. Searching the NICE guidance website uncovered an additional six technology appraisals since 2004, and one intervention appraisal [5]. As a clear disparity exists for economic evaluations for gastric cancer, we do not have an evidence-based understanding of how these costs are accumulated, or a comparative ratio of costs to benefits of commonly used treatment options to guide decision making. Few studies published in the last 20 years come from North America or Europe [3, 4, 6–9]. The majority of work evaluating the economic impact of gastric cancer and its various treatment strategies was performed in Asia, where the incidence of disease is much higher, and a larger proportion of early curative gastric cancer is diagnosed and A. L. Mahar A. Johnson Department of Public Health Sciences, Queen’s University, Kingston, Canada

Hernias through the triangle of Petit (TP) are uncommon. The anatomy of the TP is known to be variable, yet quantitative data are scant.The triangle was observed in 80 adult cadavers and its dimensions and surface area were measured.On the basis of surface area we classified the triangles into four types. Type I or small TP, with a surface area of8 cm2, accounted for 43.7% of our specimens. Type II (26.2%) were intermediate in size, with a surface areas of 8-12 cm2. Type III (12.5%) were large triangles with surface areas12 cm2. Finally, Type IV (17.5%) were not triangles. In these, the latissimus dorsi was covered by the external abdominal oblique muscle.We hope these data will help prediction of which patients are at greater risk of herniation through the TP.

Vincent Alexander Bochdalek, Czech anatomist and professor, was one of the pioneers in describing congenital diaphragmatic hernias in newborns. Interestingly, there is very little in the literature and almost nothing in the English literature regarding this important medical figure. A dedicated individual, Bochdalek had great perseverance, which allowed him to surpass obstacles in both his personal life and career. He is recognized for his accurate description of posterior diaphragmatic herniation, for which during his lifetime, there was no treatment. In addition, Bochdalek has multiple eponyms in his honor: ganglion Bochdalecki, Bochdalek's basket, and the valves of Bochdalek. Always steadfast in his beliefs, Bochdalek fought for the creation of anatomy labs in Prague against society pressures. His devoted study of anatomy, especially of congenital diaphragmatic hernias, laid the foundation for the successful surgical correction of this once lethal anomaly.