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Br J Cancer. Mar 1999; 79(9-10): 1522–1530.
PMCID: PMC2362742
Patient survival after D 1 and D 2 resections for gastric cancer: long-term results of the MRC randomized surgical trial
A Cuschieri,1 S Weeden,2 J Fielding,3 J Bancewicz,4 J Craven,5 V Joypaul,1 M Sydes,2 P Fayers,2 and for the Surgical Co-operative Group
University Department of Surgery, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
Cancer Division, MRC Clinical Trials Unit, Cambridge, UK
Queen Elizabeth Hospital, Queen Elizabeth Hospital, Birmingham, UK
University Department of Surgery, Hope Hospital, Salford, UK
Kingstown General Hospital, Kingstown General Hospital, St Vincents, Jamaica
Received July 14, 1998; Revised October 20, 1998; Accepted November 5, 1998.
Abstract
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 D 2 resections that involve a radical extended regional lymphadenectomy than with the standard D 1 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 D 1 resection (removal of regional perigastric nodes) was compared with D 2 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 D 1 resection and 33% for D 2 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 D 1 surgery). Survival based on death from gastric cancer as the event was similar in the D 1 and D 2 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 associated with poor survival. These findings indicate that the classical Japanese D 2 resection offers no survival advantage over D 1 surgery. However, the possibility that D 2 resection without pancreatico-splenectomy may be better than standard D 1 resection cannot be dismissed by the results of this trial. © 1999 Cancer Research Campaign
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