| 摘要 |
To evaluate nodal dissection effect for gastric cancer, eight prospective randomized controlled trials have been reviewed. The first two (Cape Town and Hong Kong) trials were too small to have statistical power. Two large European (Dutch and UK) trials were multi-center trials including learning periods and had difficulty in ensuring quality control. These four trials showed that nodal dissection had a high morbidity and mortality rates but no survival benefit. The Italian trial used pancreas-preserving splenectomy instead of distal pancreatic splenectomy for upper stomach cancer, which decreased morbidity and mortality. The Japanese and Polish trials compared D2 and D3 (D2 plus paraaortic lymph node dissection) resection and showed no difference in morbidity and mortality rates. The Japanese trial did not show survival benefit. We have conducted a single-center trial on advanced gastric cancer, treated by three surgeons, all of whom had received extensive training and had experience of at least 25 D2 resections. Our hospital performs about 80-100 D2 resections per year. Morbidity is higher in D2 patients, which however has not led to mortality. D2 lymph node dissection improves both overall and disease-free survival rates. Taken all these trials together, it seems likely that D2, but not D3 resection, offers a survival benefit, but the procedure should be performed by well-trained, experienced surgeons in hospital for satisfactory results. |
