Table 1.
Details and outcomes of studies included in the mini review.
| Study reference/origin | Type-methodology | Patient selection and Interventions | Results | Comments |
| Tokunaga M, 2010, Japan (11) | Retrospective cohort, Single center (n = 178) | “curative resection” PALN dissection | Morb:30%, Mort: 2%, 5yOS:13%Macroscopic type and number of positive nodes independent risk factors | PALN might be beneficial in patients with <15 + ve nodes or macro type other than Bormann 4 |
| Maeta M, 1999, Japan (12) | Prospective, pilot not randomized, single center (n = 70) | T3–T4 tumors, normal nodes in CTD3 vs D4 | D3 morb:26% D4 morb:40% SSFU ≤ 30 monthsOS NS | D4 (no 16) dissection in pts with T3–T4 tumors and normal nodes in imaging did not improve survival and was linked to increased morbidity |
| Bostanci E, 2004, Turkey (13) | Retrospective cohort, not randomized, single center (n = 134) | D2 vs D3 | D2 Morb: 10% D3 Morb: 35% Morbidity SSD2 Mort: 1% D3 Mort :8% Mortality SS | D3 can be performed with acceptable safety and might be an option for fit patients with potentially curable advanced disease |
| Kunisaki C, 2006, Japan (14) | Retrospective comparison, not randomized, multicenter (n = 580) | T4 tumors (beyond sub-serosa)D2 vs D3 | Morbidity NS (except bleeding, pulmonary and renal complications)Mortality NS | No difference in OS and DSS. D3 might be advantageous in pts with pN2 and tumors sized 50–100 mm, in terms of DSS and recurrence |
| Hu J, 2009, China (15) | Retrospective comparison, not randomized, single center (n = 117) | D2 vs D2 + PALN | D2 Morb:24,2% D2 + Morb:27,3% Morbidity NS D2 mort: 0% D2 + mort 1,8% Mortality NS Survival (5y): 65,8% vs 66,1% NS | D2 + PALN is a safe procedure in experienced hands but offers no survival advantage and cannot be implemented in current recommendations |
| De Manjoni G, 2011 and 2015, Italy (16, 17) | GIRGC retrospective database analysis, observational, multicenter (n = 568) | D2 vs D3 | – | Extend of lymphadenectomy had no impact in relapse. Pts with T3-4, with mixed/diffuse histology and upper third location might benefit from D3 dissection |
| Tsuburaya A, 2014, Japan (18) | JCOG observational, multicenter (n = 53) | “bulky” pN2 and or PAN + in imagingS1 + cisplatin (4 weeks) followed by D2 + PALN | OS (3y): 59% OS (5y): 53%Grade3/4 toxicity: 34.4% | For pts with “obvious” nodal involvement, neoadjuvant chemotherapy with S1/cisplatin followed by D2 + PALN is safe and occasionally effective |
| Kulig J, 2007, Poland (20) | PGCSG, pilot, RCT, multicenter, (n = 275) | D2 vs D2 + PALN | Interim safety analysisMorbidity: 27,7 vs 21,6% NSMortality: 4,9 vs 2,2% NS | Risk factors “fueling” complications were excessive blood loss, cardiac disease and splenectomy. No survival data reported |
| Sasako M, 2008, Japan (21) | JCOG, multicenter, RCT (n = 523) | T2b, T3, T4 and “not obvious + PALN nodes”D2 vs D2 + PALN | OS (5y): 69,2 vs 70,3% NSDFS (5y): 62,6 vs 61,7% NS | D2 + PALD compared to D2, offers no overall or recurrence free survival advantage in cT2b-T4, cPALN(−) pts |
| Yonemura Y, 2008, Japan, Taiwan, Korea (22) | EASOG, multicenter, multinational RCT (n = 269) | Pts with enlarged PALN at CT excludedD2 vs D3 | Mortality: 0,74 vs 3,73% NSOS (5y): 52,6% vs 55% NS | D3 compared to D2 lymphadenectomy offers no significant survival advantage |
| Wang Z, 2010, China (23) | Meta-analysis 4RCT, 4nonRCT trials (n = 2021) | D2 vs D2 + PALN | OS (5y): RR 0.96 vs 1.04 NS Mortality: RR 0.99 vs 2.06 NS | D2 + PALD is a safe operation but without any survival benefit compared to D2 dissection |
| Lustosa S, 2008, Brazil (26)(Asian patients) | Meta-analysis 5RCT D1vsD2vsD3 of which 2RCT D1vsD3 (n = 276) | D1 vs D3 | Morbidity RR 2.35 vs 4.07 SS OS 5(y): RR 0,83 vs 1,38 NS | D3 compared to D1 resulted to prolonged hospital stay, significant morbidity and mortality, no impact in 5 year survival |
| Yang S, 2009, China (27) | Meta-analysis 5RCT (n = 1187) | D2 vs D3 | Morbidity: 24,7 vs 29,6% NS Mortality: 2,3 vs 2,2% NS | D3 does not offer any survival benefit and could increase the risk of surgical and non-surgical complications |
| Chen X, 2010, China (28) | Meta-analysis 3RCT (n = 1067) | D2 vs D2 + PALD | Morbidity p = 0.05 SS Mortality p = 0.95 NS OS 5(y) p = 0.62 NS | D2 + PALD is linked with increased morbidity and insignificant survival gain |
| Mocellin S, 2015, Italy (29)(Asian patients) | Meta-analysis 3RCT (n = 862) | D2 vs D3 | OS 5(y) p = 0.92 NS Mortality p = 0.57 NS | No impact of D3 on overall or DFS survival, equally safe with D2 in expert’s hands |
Concluding remarks of each study are typed in bold text and listed in the outer-right column.
pts, patients; morb, morbidity; mort, mortality; DFS, disease free survival; DSS, disease specific survival; GIRGC, Group of Italian Research in Gastric Cancer; JCOG, Japanese Clinical Oncology Group; PGCSG, Polish Gastric Cancer Study Group; PALN/D, para-aortic lymph nodes/dissection; OS, overall survival; NS, non-significant; SS, statistically significant; RR, risk ratio.