Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial

作者：for the Surgical Co-operative Group, A. Cuschieri, Simon Weeden, J W L Fielding, J Bancewicz, John L Craven, Vikram Joypaul, Matthew Robert Sydes, Peter M. Fayers · 发表于：British Journal of Cancer · 年份：1999 · DOI：10.1038/sj.bjc.6690243 · 被引用次数：1384 · 研究领域：Gastric Cancer Management and Outcomes、Metastasis and carcinoma case studies、Esophageal Cancer Research and Treatment

Controversy still exists on the optimal surgical resection for potentially curable gastric cancer. Much better long-term survival has been reported in retrospective/non-randomized studies with D2 resections that involve a radical extended regional lymphadenectomy than with the standard D1 resections. In this paper we report the long-term survival of patients entered into a randomized study, with follow-up to death or 3 years in 96% of patients and a median follow-up of 6.5 years. In this prospective trial D1 resection (removal of regional perigastric nodes) was compared with D2 resection (extended lymphadenectomy to include level 1 and 2 regional nodes). Central randomization followed a staging laparotomy. Out of 737 patients with histologically proven gastric adenocarcinoma registered, 337 patients were ineligible by staging laparotomy because of advanced disease and 400 were randomized. The 5-year survival rates were 35% for D1 resection and 33% for D2 resection (difference -2%, 95% CI = -12%-8%). There was no difference in the overall 5-year survival between the two arms (HR = 1.10, 95% CI 0.87-1.39, where HR > 1 implies a survival benefit to D1 surgery). Survival based on death from gastric cancer as the event was similar in the D1 and D2 groups (HR = 1.05, 95% CI 0.79-1.39) as was recurrence-free survival (HR = 1.03, 95% CI 0.82-1.29). In a multivariate analysis, clinical stages II and III, old age, male sex and removal of spleen and pancreas were independently associate...