The Study Of Eevidence-Based Surgery For Patients With Advance Gastric Cancer

Background Gastric cancer is the second most common malignancy inthe world,and surgical resection remains the only curative treatmentoption.Patients with gastric cancer have a poor prognosis and lymphnode metastases occur during the earlier stages of this disease.Regionallymphadenectomy is recommended as part of radical gastrectomy.Although Japanese investigators stress gastrectomy with extendedlymphadenectomy (D2 and D3 resection) as standard treatments,however,the extent of lymphadenectomy to achieve the optimal result iscontroversial,and there is no worldwide consensus.But some randomizedcontrolled trials from European comparing D1 and D2 gastrectomyrevealed a high operative mortality and morbidity in the D2 group.Subgroup analysis showed a very strong independent association betweenpostoperative death and resection of the spleen in both of the largemulticentre studies.The present study try to do a meta-analysis of thepublished results to offer a more balanced view of the total evidence so asto increase statistical precision,and to determine the effectiveness andsafety after N1 lymphadenectomy (D1),N2 lymphadenectomy (D2),N3lymphadenectomy (D3) with gastrectomy for potential curative gastriccancer,or total gastrectomy combined with splenectomy (GCS) or totalgastrectomy only (GS) for potential curative gastric cancer.Methods We searched Cochrane library,MEDLINE,EMbase,TRIP Database,SUM search,CBM disc,CJFD and VIP,to find the best clinicalevidence (randomized controlled trials RCTs) for patients with advancegastric cancer.The statistical analysis was performed by RevMan 4.2.10software which was provided by the Cochrane Collaboration.There wasno statistically significant heterogeneity in our analysis,so a fixed effectmodel was used.If the results of the trials had heterogeneity,randomeffects model was used for Meta-analysis.The result was expressed withodds ratio (OR) for the dichotomous variable and weighted meandifference (WMD) for continuous variable.Results The results suggest that D2 and D3 surgery may be no anyadvantages for gastric cancer,instead it may lead to disadvantages forpatients.Total gastrectomy combined with splenectomy (GCS) may be noany advantages to 5 years survival rate.Inversely,it may lead to higherpostoperative morbidity for advanced proximal gastric cancer.Conclusions Our evidence was as follow:D2 lymphadenectomy and D3lymphadenectomy is not recommended.Total gastrectomy combinedwith splenectomy is not routinely recommended.