Wu C-W et al. (2006) Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol 7: 309–315

A single-center, randomized controlled trial conducted by researchers from Taiwan has shown that patients with gastric cancer who undergo extensive, D3 lymph-node dissection have higher survival rates than those who receive limited, D1 lymph-node dissection.

The study by Wu et al. randomized 221 patients with gastric adenocarcinoma to receive gastrectomy with either a D1 or D3 dissection at Taipei Veterans General Hospital. Each procedure was carried out by one of three surgeons, all of whom had received extensive training and had experience of at least 25 D3 dissections.

After a median follow-up of 94.5 months, 5-year disease-free survival was 59.5% in patients who underwent D3 surgery, compared with 53.6% in the D1 group (P = 0.041). Hazard analysis revealed that patients randomized to D3 surgery were almost 50% less likely to die within 5 years than those assigned to D1 surgery. After 5 years, disease had recurred in 50.6% of patients in the D1 group, compared with 40.3% in the D3 group, but the difference was not statistically significant. Multivariate analysis showed that D1 surgery was associated with poor survival, as were nodal disease, tumors occupying the whole stomach, and type III or IV tumor appearance by Borrmann's classification. The authors conclude that D3 lymph-node dissection improves both overall and disease-free survival in patients with gastric cancer, but emphasize that, to minimize morbidity, the procedure should be performed only by well-trained, experienced surgeons.