Short-Term Outcomes after D2 Gastrectomy with Complete Mesogastric Excision in Patients with Locally Advanced Gastric Cancer: A Systematic Review and Meta-Analysis of High-Quality Studies
Complete mesogastric excision (CME) has been advocated to allow for a more extensive retrieval of lymph nodes, as well as lowering loco-regional recurrence rates. This study aims to analyze the short-term outcomes of D2 radical gastrectomy with CME compared to standard D2 gastrectomy. A systematic r...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-12-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/16/1/199 |
| _version_ | 1797358977769537536 |
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| author | Stefano Granieri Annaclara Sileo Michele Altomare Simone Frassini Elson Gjoni Alessandro Germini Alessandro Bonomi Eigo Akimoto Chun Lam Wong Christian Cotsoglou |
| author_facet | Stefano Granieri Annaclara Sileo Michele Altomare Simone Frassini Elson Gjoni Alessandro Germini Alessandro Bonomi Eigo Akimoto Chun Lam Wong Christian Cotsoglou |
| author_sort | Stefano Granieri |
| collection | DOAJ |
| description | Complete mesogastric excision (CME) has been advocated to allow for a more extensive retrieval of lymph nodes, as well as lowering loco-regional recurrence rates. This study aims to analyze the short-term outcomes of D2 radical gastrectomy with CME compared to standard D2 gastrectomy. A systematic review of the literature was conducted according to the Cochrane recommendations until 2 July 2023 (PROSPERO ID: CRD42023443361). The primary outcome, expressed as mean difference (MD) and 95% confidence intervals (CI), was the number of harvested lymph nodes (LNs). Meta-analyses of means and binary outcomes were developed using random effects models to assess heterogeneity. The risk of bias in included studies was assessed with the RoB 2 and ROBINS-I tools. There were 13 studies involving 2009 patients that were included, revealing a significantly higher mean number of harvested LNs in the CME group (MD: 2.55; 95% CI: 0.25–4.86; 95%; <i>p</i> = 0.033). The CME group also experienced significantly lower intraoperative blood loss, a lower length of stay, and a shorter operative time. Three studies showed a serious risk of bias, and between-study heterogeneity was mostly moderate or high. Radical gastrectomy with CME may offer a safe and more radical lymphadenectomy, but long-term outcomes and the applicability of this technique in the West are still to be proven. |
| first_indexed | 2024-03-08T15:10:00Z |
| format | Article |
| id | doaj.art-03ad03360449490d90226232d83a9584 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-08T15:10:00Z |
| publishDate | 2023-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-03ad03360449490d90226232d83a95842024-01-10T14:53:01ZengMDPI AGCancers2072-66942023-12-0116119910.3390/cancers16010199Short-Term Outcomes after D2 Gastrectomy with Complete Mesogastric Excision in Patients with Locally Advanced Gastric Cancer: A Systematic Review and Meta-Analysis of High-Quality StudiesStefano Granieri0Annaclara Sileo1Michele Altomare2Simone Frassini3Elson Gjoni4Alessandro Germini5Alessandro Bonomi6Eigo Akimoto7Chun Lam Wong8Christian Cotsoglou9General Surgery Unit, ASST Brianza—Vimercate Hospital, 20871 Vimercate, ItalyGeneral Surgery Residency Program, University of Milan, 20122 Milan, ItalyTrauma Center and Emergency Surgery, ASST Great Metropolitan Hospital Niguarda, 20162 Milan, ItalyGeneral Surgery Residency Program, University of Pavia, 27100 Pavia, ItalyGeneral Surgery Unit, ASST Brianza—Vimercate Hospital, 20871 Vimercate, ItalyGeneral Surgery Unit, ASST Brianza—Vimercate Hospital, 20871 Vimercate, ItalyGeneral Surgery Residency Program, University of Milan, 20122 Milan, ItalyDepartment of General Surgery, Juntendo University Nerima Hospital, Tokyo 177-8521, JapanRuttonjee & Tang Siu Kin Hospital, Hong Kong, ChinaGeneral Surgery Unit, ASST Brianza—Vimercate Hospital, 20871 Vimercate, ItalyComplete mesogastric excision (CME) has been advocated to allow for a more extensive retrieval of lymph nodes, as well as lowering loco-regional recurrence rates. This study aims to analyze the short-term outcomes of D2 radical gastrectomy with CME compared to standard D2 gastrectomy. A systematic review of the literature was conducted according to the Cochrane recommendations until 2 July 2023 (PROSPERO ID: CRD42023443361). The primary outcome, expressed as mean difference (MD) and 95% confidence intervals (CI), was the number of harvested lymph nodes (LNs). Meta-analyses of means and binary outcomes were developed using random effects models to assess heterogeneity. The risk of bias in included studies was assessed with the RoB 2 and ROBINS-I tools. There were 13 studies involving 2009 patients that were included, revealing a significantly higher mean number of harvested LNs in the CME group (MD: 2.55; 95% CI: 0.25–4.86; 95%; <i>p</i> = 0.033). The CME group also experienced significantly lower intraoperative blood loss, a lower length of stay, and a shorter operative time. Three studies showed a serious risk of bias, and between-study heterogeneity was mostly moderate or high. Radical gastrectomy with CME may offer a safe and more radical lymphadenectomy, but long-term outcomes and the applicability of this technique in the West are still to be proven.https://www.mdpi.com/2072-6694/16/1/199gastric cancerD2 lymphadenectomycomplete mesogastric excisionsystematic reviewmeta-analysis |
| spellingShingle | Stefano Granieri Annaclara Sileo Michele Altomare Simone Frassini Elson Gjoni Alessandro Germini Alessandro Bonomi Eigo Akimoto Chun Lam Wong Christian Cotsoglou Short-Term Outcomes after D2 Gastrectomy with Complete Mesogastric Excision in Patients with Locally Advanced Gastric Cancer: A Systematic Review and Meta-Analysis of High-Quality Studies Cancers gastric cancer D2 lymphadenectomy complete mesogastric excision systematic review meta-analysis |
| title | Short-Term Outcomes after D2 Gastrectomy with Complete Mesogastric Excision in Patients with Locally Advanced Gastric Cancer: A Systematic Review and Meta-Analysis of High-Quality Studies |
| title_full | Short-Term Outcomes after D2 Gastrectomy with Complete Mesogastric Excision in Patients with Locally Advanced Gastric Cancer: A Systematic Review and Meta-Analysis of High-Quality Studies |
| title_fullStr | Short-Term Outcomes after D2 Gastrectomy with Complete Mesogastric Excision in Patients with Locally Advanced Gastric Cancer: A Systematic Review and Meta-Analysis of High-Quality Studies |
| title_full_unstemmed | Short-Term Outcomes after D2 Gastrectomy with Complete Mesogastric Excision in Patients with Locally Advanced Gastric Cancer: A Systematic Review and Meta-Analysis of High-Quality Studies |
| title_short | Short-Term Outcomes after D2 Gastrectomy with Complete Mesogastric Excision in Patients with Locally Advanced Gastric Cancer: A Systematic Review and Meta-Analysis of High-Quality Studies |
| title_sort | short term outcomes after d2 gastrectomy with complete mesogastric excision in patients with locally advanced gastric cancer a systematic review and meta analysis of high quality studies |
| topic | gastric cancer D2 lymphadenectomy complete mesogastric excision systematic review meta-analysis |
| url | https://www.mdpi.com/2072-6694/16/1/199 |
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