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      Patient survival after D 1 and D 2 resections for gastric cancer: long-term results of the MRC randomized surgical trial

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          Abstract

          Controversy still exists on the optimal surgical resection for potentially curable gastric cancer. Much better long-term survival has been reported in retrospective/non-randomized studies with D 2 resections that involve a radical extended regional lymphadenectomy than with the standard D 1 resections. In this paper we report the long-term survival of patients entered into a randomized study, with follow-up to death or 3 years in 96% of patients and a median follow-up of 6.5 years. In this prospective trial D 1 resection (removal of regional perigastric nodes) was compared with D 2 resection (extended lymphadenectomy to include level 1 and 2 regional nodes). Central randomization followed a staging laparotomy.

          Out of 737 patients with histologically proven gastric adenocarcinoma registered, 337 patients were ineligible by staging laparotomy because of advanced disease and 400 were randomized. The 5-year survival rates were 35% for D 1 resection and 33% for D 2 resection (difference –2%, 95% CI = –12%–8%). There was no difference in the overall 5-year survival between the two arms (HR = 1.10, 95% CI 0.87–1.39, where HR > 1 implies a survival benefit to D 1 surgery). Survival based on death from gastric cancer as the event was similar in the D 1 and D 2 groups (HR = 1.05, 95% CI 0.79–1.39) as was recurrence-free survival (HR = 1.03, 95% CI 0.82–1.29). In a multivariate analysis, clinical stages II and III, old age, male sex and removal of spleen and pancreas were independently associated with poor survival. These findings indicate that the classical Japanese D 2 resection offers no survival advantage over D 1 surgery. However, the possibility that D 2 resection without pancreatico-splenectomy may be better than standard D 1 resection cannot be dismissed by the results of this trial. © 1999 Cancer Research Campaign

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          Author and article information

          Journal
          Br J Cancer
          British Journal of Cancer
          Nature Publishing Group
          0007-0920
          1532-1827
          March 1999
          : 79
          : 9/10
          : 1522-1530
          Affiliations
          [1 ]University Department of Surgery, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
          [2 ]Cancer Division, MRC Clinical Trials Unit, Cambridge, UK
          [3 ]Queen Elizabeth Hospital, Queen Elizabeth Hospital, Birmingham, UK
          [4 ]University Department of Surgery, Hope Hospital, Salford, UK
          [5 ]Kingstown General Hospital, Kingstown General Hospital, St Vincents, Jamaica
          Article
          6690243
          10.1038/sj.bjc.6690243
          2362742
          10188901
          bdadd347-d4c1-48fe-9470-c4f47b8eeeaa
          Copyright 1999, Cancer Research Campaign
          History
          : 14 July 1998
          : 20 October 1998
          : 05 November 1998
          Categories
          Regular Article

          Oncology & Radiotherapy
          gastric cancer,d 1 resection,d 2 resection,long-term survival
          Oncology & Radiotherapy
          gastric cancer, d 1 resection, d 2 resection, long-term survival

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