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- Title
Randomized clinical trial on D2 lymphadenectomy versus D2 lymphadenectomy plus complete mesogastric excision in patients undergoing gastrectomy for cancer (DCGC01 study).
- Authors
Xie, Daxing; Shen, Jie; Liu, Liang; Cao, Beibei; Xiao, Aitang; Qin, Jichao; Wu, Jianhong; Yan, Qun; Hu, Yuanlong; Yang, Chuanyong; Cao, Zhixin; Hu, Junbo; Yin, Ping; Gong, Jianping
- Abstract
Background: It is unknown whether D2 lymphadenectomy + complete mesogastric excision for gastric cancer improves survival compared with just D2 lymphadenectomy. Methods: Between September 2014 and June 2018, patients with advanced gastric cancer were randomly assigned (1 : 1) to laparoscopic D2 lymphadenectomy or D2 lymphadenectomy + complete mesogastric excision gastrectomy. The modified intention-to-treat population was defined as patients who had pathologically confirmed gastric adenocarcinoma (pT1 N1–3 M0 and pT2–4 N0–3 M0). The primary endpoint was 3-year disease-free survival. Secondary endpoints were the recurrence pattern and overall survival. Results: The median follow-up of patients in the D2 lymphadenectomy group (169 patients) and patients in the D2 lymphadenectomy +complete mesogastric excision group (169 patients) was 55 (interquartile range 37–60) months and 51 (interquartile range 40–60) months respectively. Recurrence occurred in 50 patients in the D2 lymphadenectomy group (29.6%) versus 33 patients in the D2 lymphadenectomy + complete mesogastric excision group (19.5%) (P = 0.032). The 3-year disease-free survival was 75.5% (95% c.i. 68.3% to 81.3%) in the D2 lymphadenectomy group versus 85.0% (95% c.i. 78.7% to 89.6%) in the D2 lymphadenectomy + complete mesogastric excision group (log rank P = 0.042). The HR for recurrence in the D2 lymphadenectomy + complete mesogastric excision group versus the D2 lymphadenectomy group was 0.64 (95% c.i. 0.41 to 0.99) by Cox regression (P = 0.045). The 3-year overall survival rate was 77.5% (95% c.i. 70.4% to 83.1%) in the D2 lymphadenectomy group versus 85.8% (95% c.i. 79.6% to 90.2%) in the D2 lymphadenectomy + complete mesogastric excision group (log rank P = 0.058). The HR for death in the D2 lymphadenectomy + complete mesogastric excision group versus the D2 lymphadenectomy group was 0.64 (95% c.i. 0.41 to 1.02) (P = 0.058). Conclusion: Compared with conventional D2 dissection, D2 lymphadenectomy + complete mesogastric excision is associated with better disease-free survival, but there is no statistically significant difference in overall survival. Registration number: NCT01978444 (http://www.clinicaltrials.gov). Compared with conventional D2 dissection, D2 + complete mesogastric excision shows favourable oncological outcomes in curable advanced gastric cancer.
- Subjects
LYMPHADENECTOMY; CLINICAL trials; GASTRECTOMY; CANCER patients; OVERALL survival; PROGRESSION-free survival
- Publication
British Journal of Surgery, 2024, Vol 111, Issue 5, p1
- ISSN
0007-1323
- Publication type
Article
- DOI
10.1093/bjs/znae106