胃癌根治术D1与D2淋巴结清扫临床疗效和安全性的荟萃分析

目的系统评价胃癌根治术中D1与D2两种不同范围淋巴结清扫的临床疗效及其安全性。方法检索近20年来有关胃癌根治术不同淋巴结清扫范围的随机对照临床研究文献,评估文献质量并提取数据资料,应用荟萃分析专用软件包RevMan(4.2版)进行统计分析。结果共检索到初始相关文献394篇,经质量评估后其中4篇文献符合本研究要求,共1316例患者被纳入分析。Meta分析结果显示,相对于D1术式,标准D2术式可有效改善患者远期生存RR1.35,95%CI(1.12～1.62);NNT=9];若同时纳入联合脾脏或胰体尾脾切除的病例,D2术式只对已突破浆膜(T3)的胃癌患者有意义RR1.80,95%CI(1.03～3.15);NNT=13];D2术式术后并发症发生率RR1.72,95%CI(1.46～2.03);NNT=6]及死亡率RR2.12,95%CI(1.39～3.25);NNT=21]高于D1术式。结论与D1术式相比,标准的D2根治术可显著提高胃癌患者的远期生存率,而同时联合胰体尾和(或)脾脏切除的D2根治术只能改善T3期胃癌患者的预后;D2根治术的术后并发症发生率及死亡率高于D1根治术。

Clinical values of extended lymph node dissection for gastric cancer :a meta-analysis for D1 versus D2 gastrectomy

Objective To evaluate the survival,complication and postoperative mortality after D1 or D2 lymph node dissection for gastric cancer. Methods All the randomized clinical trials about nodal dissection for gastric cancer published within the last 20 years were collected. Quality assessment was done on each trial and relevant data were extracted from qualified trials. Meta-analysis was performed with the use of RevMan 4.2 (Cochrane) for statistic analysis. Results Three hundred and ninety-four trials were yielded at the initial search. Four trials,recruited 1316 cases of gastric cancer in total,were included after quality assessment. Results of Meta-analysis showed that standard D2 dissection could effectively improve patients' long-term survival RR 1.35,95%CI(1.12-1.62),NNT=9 as compared with D1 dissection. If splenectomy (or pancreatico-splenectomy) was involved,D2 dissection only improved the clinical outcome of T3-staged cases RR 1.80,95%CI(1.03-3.15),NNT=13. D2 dissection produced higher rates of postoperative complication RR 1.72,95%CI(1.46-2.03),NNT=6 and mortality RR 2.12,95%CI(1.39-3.25),NNT=21 than D1 dissection. Conclusions Standard D2 dissection can increase the overall survival rate when compared with D1 dissection. If splenectomy (or pancreatico-splenectomy) cases are involved,D2 dissection can only improve the survival rate of T3-staged patients. D2 dissection yields higher postoperative morbidity and mortality than D1 dissection.