Meta-analysis of randomized controlled trials comparing D2 and D4 lymphadenectomy for gastric cancer.

BACKGROUND: The aim of the study was to assess the efficacy and safety of D2 compared with D4 surgery in patients treated with curative intent. METHODS: An electronic search of the Cochrane Central Register of Controlled Trials, PubMed, Embase, ISI databases and Chinese Biomedical Literature Database was conducted till September 2010 to identify randomized controlled trials on related studies. Statistic analyses were carried out using RevMan software. RESULTS: Three randomized controlled trials with 1067 patients were included. The meta-analysis showed that D4 dissection tended to be associated with slightly higher 5-year survival rate, but there were no statistically significant differences between two groups [OR = 0.93, 95% CI (0.69-1.25)]. However, there appeared to be no statistically differences between D2 and D4 group in terms of recurrences of cancer, re-operation, hospital mortality, overall morbidity, anastomotic leakage, pancreatic fistula, operation time, though pulmonary increased in the D2 group comparing to that in the D4 group. CONCLUSIONS: Prophylactic D4 dissection is not recommended for patients with curable gastric cancer. [ABSTRACT FROM AUTHOR]