The Clinical Reliability And Validity Of Different Levels(D1Versus D2) Of Nodal Resection For Gastric Carcinoma:a Meta-analysis

Objective：To evaluate the Complication survival and postoperativemortality after disparity levels （D1versus D2）of lymph node removalfor Gastric cancer with the utilization of Mata-analysis．Methods and Material： With the application of various kindsdatabases and method of science to retrieve．All the randomized clinicaltrials to nodal removal for gastric cancer （D1versus D2）publishedincluding the last20years were gathered．With the purpose of the qualityliterature under guideline of Meta-Analysis. The statistic calculationswas performed with the use of Meta–Analysis Revman5.2（Cochrane）.Results：At the initial search，literatures were yielded. After qualityassessment，3randomized clinical trials recruited and1378gastric cancercases in total，were included. On the basis of result of Meta-analysis，aftera randomized D1or D2gastric radical operation，the D2dissectionpostoperative survival rate of long-term at T3-staged is higher than D1.But the result is not statistically significant. The rate is 【RR=1.47，95%CI(0.91,2.38),Z=1.57,P=0.12. The D1dissection postoperativesurvival rate of long-term at T1-2staged is higher than D2. But the result is not statistically significant. The rate is 【RR=0.93，95%CI(0.77,1.13),Z=0.71,P=0.48】. The D2dissection postoperativesurvival rate of long-term is higher than D1. But the result is notstatistically significant. The rate is 【RR=1.25，95%CI(0.92,1.68),Z=1.44,P=0.15】. The D2dissection postoperative replase free survival rateof long-term is higher than D1. The result is statistically significant. Therate is 【RR=1.31，95%CI(1.05,1.63),Z=2.38,P=0.02】. The D2dissectionpostoperative death rate is higher than D1. The result is statisticallysignificant. The rate is 【RR=2.02，95%CI(1.30,3.14),Z=3.14,P=0.002】.The D2dissection postoperative complication rate is higher than D1. Theresult is statistically significant. The rate is 【RR=1.69，95%CI(1.44,1.99),Z=6.37,P＜0.00001】. The D2dissection postoperative reoperation rate ishigher than D1. The result is statistically significant. The rate is 【RR=2.17，95%CI(1.46,3.24),Z=3.81,P=0.0001】. Postoperative overall survival oflongterm of patients with (pancreatico-)splenectomy cases and(pancreatico-)spleen preservation cases with D1or D2are not statisticallysignificant. The result in D1is 【RR=0.55，95%CI(0.13,2.39), Z=1.78（P=0.08）】. The result in D2is 【RR=0.29，95%CI(0.08,1.14), Z=1.78（P=0.08）】.Conclusion： Standard D2dissection could increase the overallsurvival-free rate of long-term when compared with D1dissection. D2dissection yielded higher rates of postoperative morbidity，reoperation and mortality than D1dissection.(Pancreatico-) splenectomy cases involvedare not routine to recommend.