Long-Term Impact of D2 Lymphadenectomy during Gastrectomy for Cancer: Individual Patient Data Meta-Analysis and Restricted Mean Survival Time Estimation

Simple Summary Debate exists regarding the effect of D2 vs. D1 lymphadenectomy on long-term oncological outcomes after gastrectomy for cancer. The aim of our individual patient data meta-analysis was to assess the impact of D2 lymphadenectomy on long-term survival after gastrectomy for gastric cancer. Compared with previous randomized trials, we confirmed a trend toward improved overall survival (1.8 months; 95% CI -4.2, 0.7; p = 0.14), cancer specific survival (1.2 months, 95% CI -3.9, 5.7; p = 0.72), and disease-free survival (0.8 months, 95% CI -1.7, 3.4; p = 0.53) at 60-month follow-up for D2 lymphadenectomy. Compared to D1, D2 lymphadenectomy is associated with a clinical trend toward improved OS, CSS, and DFS at 60-month follow-up.Abstract Background: Debate exists concerning the impact of D2 vs. D1 lymphadenectomy on long-term oncological outcomes after gastrectomy for cancer. Methods: PubMed, MEDLINE, Scopus, and Web of Science were searched and randomized controlled trials (RCTs) analyzing the effect of D2 vs. D1 on survival were included. Overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) were assessed. Restricted mean survival time difference (RMSTD) and 95% confidence intervals (CI) were used as effect size measures. Results: Five RCTs (1653 patients) were included. Overall, 805 (48.7%) underwent D2 lymphadenectomy. The RMSTD OS analysis shows that at 60-month follow-up, D2 patients lived 1.8 months (95% CI -4.2, 0.7; p = 0.14) longer on average compared to D1 patients. Similarly, 60-month CSS (1.2 months, 95% CI -3.9, 5.7; p = 0.72) and DFS (0.8 months, 95% CI -1.7, 3.4; p = 0.53) tended to be improved for D2 vs. D1 lymphadenectomy. Conclusions: Compared to D1, D2 lymphadenectomy is associated with a clinical trend toward improved OS, CSS, and DFS at 60-month follow-up.