Zoekstrategie versie 2.2 (2017) Lymfadenectomie

  
  Zoekstrategie versie 2.2. (2017) Lymfadenectomie > Bijlage    Sluit venster
 

Laatst gewijzigd : 2017-03-01 Verantwoording: Landelijke werkgroep Gastro-intestinale Tumoren Versie: 2.2 Type: Landelijke richtlijn

Methodology report

RL Maag PICO 7

 

1   KEY QUESTION

Wat zijn de gewenste en ongewenste effecten van beperkte lymfeklierdissectie in vergelijking met uitgebreide lymfeklierdissectie bij patiënten met in opzet curatief te behandelen maagcarcinoom (bij totale resectie)?

 

P Patiënten met in opzet curatief te behandelen maagcarcinoom (cT0-4N0-3M0).

I Beperkte/limited (D1) lymfeklierdissectie

C Uitgebreide/extended (D2,D3,D4) lymfeklierdissectie

O Overall survival, locoregional recurrence, disease free survival, postoperatieve mortaliteit, reoperaties, naadlekkage, pneumonie en algemene postoperatieve complicaties

 

 

2   GOLDEN HITS

#

Ref

In- or exclusion

Comment

1

El-Sedfy A, Dixon M, Seevaratnam R, Bocicariu A, Cardoso R, Mahar A, Kiss A, Helyer L, Law C, Coburn NG. Personalized Surgery for Gastric Adenocarcinoma: A Meta-analysis of D1 versus D2 Lymphadenectomy. Ann Surg Oncol. 2015 Jun;22(6):1820-7. doi: 10.1245/s10434-014-4168-6. Epub 2014 Oct 28.

exclude

Systematic review not included since no statification on geography

2

Jiang L, Yang KH, Chen Y, Guan QL, Zhao P, Tian JH, Wang Q. Systematic review and meta-analysis of the effectiveness and safety of extended lymphadenectomy in patients with resectable gastric cancer. Br J Surg. 2014 May;101(6):595-604. doi: 10.1002/bjs.9497. Epub 2014 Mar 25.

Exclude

Systematic review not included since no statification on geography

3

Songun I, Putter H, Meershoek-Klein Kranenbarg E, et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomized nationwide D1D2 trial. Lancet Oncology 2010; 11(5):439-449.

Include

 

4

Degiuli M, Sasako M, Ponti A, et al. Randomized clinical trial comparing survival after D1 or D2 gastrectomy for gastric cancer. Br J Surg 2014; 101(2):23-31.

Include

 

5

Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, Hiratsuka M, Tsujinaka T, Kinoshita T, Arai K, Yamamura Y, Okajima K; Japan Clinical Oncology Group. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008 Jul 31;359(5):453-62.

Exclude

Comparison D2 vs D2 PAND

6

Memon MA, Subramanya MS, Khan S, Hossain MB, Osland E, Memon B. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Ann Surg. 2011;253(5):900-11.

exclude

Systematic review not included since no statification on geography

7

McCulloch P, Nita ME, Kazi H, Gama-Rodrigues JJ. WITHDRAWN: Extended versus limited lymph nodes dissection technique for adenocarcinoma of the stomach. Cochrane Database Syst Rev. 2012 Jan 18;1:CD001964.

Include, however withdrawn

 

 

3   SEARCH STRATEGY

The searches were run on 20 nov 2015. Pubmed Medline, Embase, Cochrane (CDSR,DARE, Central) were searched. Detailed search strings are given below. The searches were limited to 2008-2015, English, Dutch and German. Study types: systematic reviews, meta-analysis and RCTs.

4   SEARCH RESULTS

The Medline search yielded  681 hits, while  the search in Embase yielded 189 hits, Cochrane yielded 137 hits.

 

After merging the search files into one file and removal of the duplicates 974 records were screened on title and abstract. Of these 923 were excluded. The most important reasons for exclusion was that studies were

  1. Patient population
  2. InterventionOf the remaining 51 studies, the full text was retrieved. Based on the full text, an additional 48 studies were excluded. Table 4.1 provides an overview of the studies included in the full text screening.
  3.  

4.1   Table of references for full text screening

 

#

Reference

In- or exclusion

Comment

1

Barreto SG, Shukla PJ. Nodal dissection for gastric cancer. The New England journal of medicine. 2008;359(22):2392; author reply 3.#http://www.nejm.org/doi/pdf/10.1056/NEJMc081856

Exclude

Letter to editor

2

Batista TP, Martins MR. Lymph node dissection for gastric cancer: a critical review. Oncology reviews. 2012;6(1):e12.#http://www.oncologyreviews.org/index.php/or/article/download/oncol.2012.e12/pdf

Exclude

Narrative review

3

Bischof DA, Swallow CJ, Stotland PK, et al. Incorporation of laparoscopic D2 dissection into the management of gastric adenocarcinoma (GCa) in a community-based setting. Journal of Clinical Oncology. 2012;30(4).#http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L71011348

Exclude

Conference abstract

4

Bouras G, Lee SW, Nomura E, et al. Comparative analysis of station-specific lymph node yield in laparoscopic and open distal gastrectomy for early gastric cancer. Surgical laparoscopy, endoscopy & percutaneous techniques. 2011;21(6):424-8

Exclude

Laparoscopic vs open surgery

5

Brar SS, Seevaratnam R, Cardoso R, et al. A systematic review of spleen and pancreas preservation in extended lymphadenectomy for gastric cancer. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2012;15 Suppl 1:S89-99

Exclude

systematic review of the evidence for preservation of the spleen and pancreas in extended lymphade-

nectomy during surgical therapy for gastric cancer.

6

Cao X, Wang Q, Abdikarim I, et al. Clinical application of fast track surgery with laparoscopic-assisted gastrectomy for advanced gastric cancer. Journal of Gastroenterology and Hepatology (Australia). 2014;29:272

Exclude

Conference abstract

7

Chen XZ, Hu JK, Zhou ZG, et al. Meta-analysis of effectiveness and safety of D2 plus para-aortic lymphadenectomy for resectable gastric cancer. Journal of the American College of Surgeons. 2010;210(1):100-5

Exclude

D2 vs D2+PALD

8

Cheng LY, Xie ZY, Dai GR, et al. [Preliminary experiences of application of sentinel lymph node navigation technique in early gastric cancer]. Zhonghua wai ke za zhi [Chinese journal of surgery] [Internet]. 2008; 46(14):[1076-9 pp.]. # http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/092/CN-00688092/frame.html

Exclude

Sentinel node biopsy

9

de Steur WO, Hartgrink HH, Dikken JL, et al. Quality control of lymph node dissection in the Dutch Gastric Cancer Trial. The British journal of surgery. 2015;102(11):1388-93

include

 

10

Degiuli M. Effectiveness of D2 gastrectomy for lymph node positive and advanced gastric cancer: Survival results of the Italian Gastric Cancer Study Group (IGCSG) randomized surgical trial on D1 versus D2 dissection for gastric carcinoma. Journal of clinical oncology [Internet]. 2013; 31(15 suppl. 1).

Exclude

Conference abstract

11

Degiuli M, Sasako M, Ponti A, et al. Randomized clinical trial comparing survival after D1 or D2 gastrectomy for gastric cancer. The British journal of surgery. 2014;101(2):23-31

Include

D1 vs D2 (IGCSG-R01)

12

El-Sedfy A, Dixon M, Seevaratnam R, et al. Personalized Surgery for Gastric Adenocarcinoma: A Meta-analysis of D1 versus D2 Lymphadenectomy. Annals of surgical oncology. 2015;22(6):1820-7

Exclude

Systematic review not included since no statification on geography

13

Fujimura T, Nakamura K, Oyama K, et al. Selective lymphadenectomy of para-aortic lymph nodes for advanced gastric cancer. Oncology reports. 2009;22(3):509-14

Exclude

Observational study

14

Galizia G, Lieto E, De Vita F, et al. Modified versus standard D2 lymphadenectomy in total gastrectomy for nonjunctional gastric carcinoma with lymph node metastasis. Surgery. 2015;157(2):285-96

Include

D1+ vs D2

15

He W, Tu J, Huo Z, et al. Surgical interventions for gastric cancer: a review of systematic reviews. International journal of clinical and experimental medicine. 2015;8(8):13657-69

exclude

Narrative review

16

Hu JK, Yang K, Zhang B, et al. D2 plus para-aortic lymphadenectomy versus standardized D2 lymphadenectomy in gastric cancer surgery. Surgery today. 2009;39(3):207-13.#http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L354324507

Exclude

D2 PALD vs D2

17

Imamura H, Kurokawa Y, Kawada J, et al. Influence of bursectomy on operative morbidity and mortality after radical gastrectomy for gastric cancer: results of a randomized controlled trial. World journal of surgery. 2011;35(3):625-30

Exclude

D2 Bursectomy vs D2 non bursectomy

18

Iqbal N, Lovegrove RE, Tilney HS, et al. A comparison of pancreaticoduodenectomy with extended pancreaticoduodenectomy: a meta-analysis of 1909 patients. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2009;35(1):79-86

Exclude

Pancreaticoduodenectomy vs extended pancreaticoduodenectomy

19

Irino T, Hiki N, Nunobe S, et al. Subtotal gastrectomy with limited lymph node dissection is a feasible treatment option for patients with early gastric stump cancer. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2014;18(8):1429-33

Exclude

Gastric stump cancer

20

Jiang L, Yang KH, Guan QL, et al. Survival and recurrence free benefits with different lymphadenectomy for resectable gastric cancer: a meta-analysis. Journal of surgical oncology. 2013;107(8):807-14

Exclude

Systematic review not included since no statification on geography

21

Jiang L, Yang KH, Chen Y, et al. Systematic review and meta-analysis of the effectiveness and safety of extended lymphadenectomy in patients with resectable gastric cancer. The British journal of surgery. 2014;101(6):595-604.#http://www.ncbi.nlm.nih.gov/pubmed/24668465

Exclude

Systematic review not included since no statification on geography

22

Kawamura H, Homma S, Yokota R, et al. Inspection of safety and accuracy of D2 lymph node dissection in laparoscopy-assisted distal gastrectomy. World journal of surgery. 2008;32(11):2366-70

Exclude

LADG vs ODG

23

Kim YW, Park YK, Yoon HM, et al. Result of clinical study on feasibility of laparoscopy-assisted D2 distal gastrectomy to treat advanced gastric cancer (COACT-1001). Journal of clinical oncology [Internet]. 2013; 31

Exclude

Conference abstract

24

Kim HI, Hur H, Kim YN, et al. Standardization of D2 lymphadenectomy and surgical quality control (KLASS-02-QC): a prospective, observational, multicenter study [NCT01283893]. BMC cancer. 2014;14:209.#http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000001/pdf/1471-2407-14-209.pdf

Exclude

Observational study

25

Kim J, Eom BW, Nam BH, et al. ADDICT-A multicenter randomized clinical trial of D1+ versus D2 distal gastrectomy for stage IB & II advanced gastric cancer: Design and rationale. European journal of surgical oncology [Internet]. 2014; 40(11):[S162 p.]. # http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/036/CN-01088036/frame.html

Exclude

Conference abstract

26

Kurokawa Y, Sasako M, Sano T, et al. Functional outcomes after extended surgery for gastric cancer. The British journal of surgery. 2011;98(2):239-45.

Exclude

D2 lymphadenectomy

alone vs D2 lymphadenectomy plus PAND

27

Liakakos T, Patapis P, Charalambopoulos A, et al. Laparoscopic D2 gastrectomy: time for a randomized trial. World journal of surgery. 2009;33(7):1542-3; author reply

Exclude

Author reply

28

Liu N, Niu Z, Niu W, et al. Intraoperative sentinel lymph node mapping guides laparoscopic-assisted distal gastrectomy for distal gastric cancer. International journal of clinical and experimental medicine. 2015;8(4):5760-6.#http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4483915/pdf/ijcem0008-5760.pdf

Exclude

Sentinel lymph node mapping

29

Lustosa SA, Saconato H, Atallah AN, et al. Impact of extended lymphadenectomy on morbidity, mortality, recurrence and 5-year survival after gastrectomy for cancer. Meta-analysis of randomized clinical trials. Acta cirurgica brasileira / Sociedade Brasileira para Desenvolvimento Pesquisa em Cirurgia. 2008;23(6):520-30

Exclude

Systematic review not included since no statification on geography

30

McCulloch P, Nita ME, Kazi H, et al. WITHDRAWN: Extended versus limited lymph nodes dissection technique for adenocarcinoma of the stomach. The Cochrane database of systematic reviews. 2012;1:Cd001964

Exclude

Withdrawn

31

Memon MA, Subramanya MS, Khan S, et al. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Annals of surgery. 2011;253(5):900-11

Exclude

Systematic review not included since no statification on geography

32

Mocellin S, McCulloch P, Kazi H, et al. Extent of lymph node dissection for adenocarcinoma of the stomach. The Cochrane database of systematic reviews. 2015;8:

Exclude

Systematic review not included since no statification on geography

33

Mocellin S, Nitti D. Lymphadenectomy extent and survival of patients with gastric carcinoma: a systematic review and meta-analysis of time-to-event data from randomized trials. Cancer treatment reviews. 2015;41(5):448-54

Exclude

Systematic review not included since no statification on geography

34

Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. The New England journal of medicine. 2008;359(5):453-62

Exclude

D2 PAND vs D2

35

Schmidt B, Chang KK, Maduekwe UN, et al. D2 lymphadenectomy with surgical ex vivo dissection into node stations for gastric adenocarcinoma can be performed safely in Western patients and ensures optimal staging. Annals of surgical oncology. 2013;20(9):2991

Exclude

Retrospective chart review

36

Schmidt B, Yoon SS. D1 versus D2 lymphadenectomy for gastric cancer. Journal of surgical oncology. 2013;107(3):259-64

Exclude

Narrative review

37

Seevaratnam R, Bocicariu A, Cardoso R, et al. A meta-analysis of D1 versus D2 lymph node dissection. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2012;15 Suppl 1:S60-9.

Exclude

Systematic review not included since no statification on geography

38

Songun I, Putter H, Kranenbarg EM, et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. The Lancet Oncology. 2010;11(5):439-49

Include

Dutch D1D2 trial

39

Strong VE, Yoon SS. Extended lymphadenectomy in gastric cancer is debatable. World journal of surgery. 2013;37(8):1773-7

Exclude

Narrative review

40

Tanizawa Y, Terashima M. Lymph node dissection in the resection of gastric cancer: review of existing evidence. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2010;13(3):137-48

Exclude

Systematic review not included since no statification on geography

41

Tokunaga M, Hiki N, Fukunaga T, et al. Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection following standardization--a preliminary study. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2009;13(6):1058-63a

Exclude

Observational study

42

Vallbohmer D, Oh DS, Peters JH. The role of lymphadenectomy in the surgical treatment of esophageal and gastric cancer. Current problems in surgery. 2012;49(8):471-515

Exclude

Narrative review

43

Verlato G, Giacopuzzi S, Bencivenga M, et al. Problems faced by evidence-based medicine in evaluating lymphadenectomy for gastric cancer. World journal of gastroenterology : WJG. 2014;20(36):12883-91.#http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4177470/pdf/WJG-20-12883.pdf

Exclude

Narrative review

44

Wang Z, Chen JQ, Cao YF. Systematic review of D2 lymphadenectomy versus D2 with para-aortic nodal dissection for advanced gastric cancer. World journal of gastroenterology : WJG. 2010;16(9):1138-49

exclude

D2 PAND vs D2

45

Wei JM, Shiraishi N, Goto S, et al. Laparoscopy-assisted distal gastrectomy with D1+beta compared with D1+alpha lymph node dissection. Surgical endoscopy. 2008;22(4):955-60.

Exclude

D1+beta vs D1+alpha?

46

Yang SH, Zhang YC, Yang KH, et al. An evidence-based medicine review of lymphadenectomy extent for gastric cancer. American journal of surgery. 2009;197(2):246-51

Exclude

Systematic review not included since no statification on geography

47

Yao XX, Yan C, Yan M, et al. [A comparative study on the efficacy of spleen-preserving modified D2 radical gastrectomy and D2 radical gastrectomy with splenectomy]. Zhonghua wei chang wai ke za zhi [Chinese journal of gastrointestinal surgery] [Internet]. 2010; 13(2):[111-4 pp.].

Exclude

Chinese

48

Yonemura Y, Wu CC, Fukushima N, et al. Randomized clinical trial of D2 and extended paraaortic lymphadenectomy in patients with gastric cancer. International journal of clinical oncology. 2008;13(2):132-7

Exclude

D2 vs extended D2

49

Yoon SS, Yang HK. Lymphadenectomy for gastric adenocarcinoma: should west meet east? The oncologist. 2009;14(9):871-82

Exclude

Narrative review

50

Zhang C, He Y, Schwarz RE, et al. Evaluation of para-aortic nodal dissection for locoregionally advanced gastric cancer with 1-3 involved para-aortic nodes. Chinese medical journal. 2014;127(3):435-41

Exclude

Chart review

51

Zheng B, Ma B, Yang K, et al. Meta-analysis of randomized controlled trials comparing D2 and D4 lymphadenectomy for gastric cancer. European Surgery - Acta Chirurgica Austriaca. 2011;43(5):255-61

Exclude

Systematic review not included since no statification on geography

 

Search syntax are detailed in appendix

 

Appendix

 

Pubmed Medline

20 nov 2015

 

Patients:

 

#1        "Stomach Neoplasms"[Mesh]

#2        stomach[tiab] AND neoplas*[tiab]

#3        stomach[tiab] AND cancer*[tiab]

#4        stomach[tiab] AND carcin*[tiab]

#5        stomach[tiab] AND tumo*[tiab]

#6        stomach[tiab] AND malig*[tiab]

#7        gastric[tiab] AND neoplas*[tiab]

#8        gastric[tiab] AND cancer*[tiab]

#9        gastric[tiab] AND carcin*[tiab]

#10       gastric[tiab] AND tumo*[tiab]

#11       gastric[tiab] AND malig*[tiab]

#12       Stomach[Mesh]

#13       neoplas*[tiab] OR cancer*[tiab] OR carcin*[tiab] OR tumor*[tiab] OR tumour*[tiab]] OR malig*[tiab] OR "Neoplasms"[Mesh]

#14       #12 AND #13

#15       #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #10 OR #11 OR #14

 

((((((((("Stomach Neoplasms"[Mesh]) OR ((stomach[tiab] AND neoplas*[tiab]))) OR ((stomach[tiab] AND cancer*[tiab]))) OR ((stomach[tiab] AND carcin*[tiab]))) OR ((stomach[tiab] AND malig*[tiab]))) OR ((gastric[tiab] AND neoplas*[tiab]))) OR ((gastric[tiab] AND cancer*[tiab]))) OR ((gastric[tiab] AND carcin*[tiab))) OR ((gastric[tiab] AND malig*[tiab]))) OR ((gastric[tiab] AND (tumor*[tiab] OR tumour*[tiab])) OR ((stomach[tiab] AND (tumor*[tiab] OR tumour*[tiab])))) OR ((Stomach[Mesh]) AND ((neoplas*[tiab] OR cancer*[tiab] OR carcin*[tiab] OR tumor*[tiab] OR tumour*[tiab] OR malig*[tiab] OR "Neoplasms"[Mesh]))) 121490

Intervention:

#16 Lymphadenectom*[tiab] 13162

#17 "Lymph Node Excision"[Mesh] 37932

#18 lymph[tiab] AND node[tiab] AND (excision[tiab] OR dissection[tiab]) 4436

#19 #16 OR #17 OR #18

"Lymph Node Excision"[Mesh] OR Lymphadenectom*[tiab] OR (lymph[tiab] AND node[tiab] AND (excision[tiab] OR dissection[tiab])) 52789

 

P AND I: 5040

 

RCT-filter

(randomized controlled trial[pt] OR controlled clinical trial[pt] OR randomized[tiab] OR placebo[tiab] OR drug therapy[sh] OR randomly[tiab] OR trial[tiab] OR groups[tiab]) 3689106

P AND I and RCT: 1658

Sys rev filter

((review[tiab] OR "Review"[Publication Type] OR "Meta-Analysis as Topic"[Mesh] OR meta-analysis[tiab] OR "Meta-Analysis "[Publication Type]) NOT ("Letter"[Publication Type] OR "Editorial"[Publication Type] OR "Comment"[Publication Type])) NOT ("Animals"[Mesh] NOT ("Animals"[Mesh] AND "Humans"[Mesh])) 2344508

P AND I and Sys Rev: 914

P.I SysRev AND RCT: 2256

Limit 2008-2015, Eng Dutch German: 861

 

Embase 20 nov 2015

Patients

'stomach cancer'/exp OR (stomach NEAR/5 neoplas*):ab,ti OR (gastric NEAR/5 neoplas*):ab,ti OR (stomach NEAR/5 cancer*):ab,ti OR (gastric NEAR/5 cancer*):ab,ti OR (stomach NEAR/5 carcin*):ab,ti OR (gastric NEAR/5 carcin*):ab,ti OR (stomach NEAR/5 tumo*):ab,ti OR (gastric NEAR/5 tumo*):ab,ti OR (stomach NEAR/5 malig*):ab,ti OR (gastric NEAR/5 malig*):ab,ti  121,167

 

Intervention:

'lymphadenectomy'/exp OR 'lymphadenectomy':ab,ti OR 'lymph node excision'/exp OR 'lymph node excision':ab,ti OR ‘lymph node dissection’:ab,ti 59,792

 

P AND I:

'stomach cancer'/exp OR (stomach NEAR/5 neoplas*):ab,ti OR (gastric NEAR/5 neoplas*):ab,ti OR (stomach NEAR/5 cancer*):ab,ti OR (gastric NEAR/5 cancer*):ab,ti OR (stomach NEAR/5 carcin*):ab,ti OR (gastric NEAR/5 carcin*):ab,ti OR (stomach NEAR/5 tumo*):ab,ti OR (gastric NEAR/5 tumo*):ab,ti OR (stomach NEAR/5 malig*):ab,ti OR (gastric NEAR/5 malig*):ab,ti AND ('lymphadenectomy'/exp OR 'lymphadenectomy':ab,ti OR 'lymph node excision'/exp OR 'lymph node excision':ab,ti OR ‘lymph node dissection’:ab,ti ) 5736

 

 

Sys Rev,RCT filter::

('stomach cancer'/exp OR (stomach NEAR/5 neoplas*):ab,ti OR (gastric NEAR/5 neoplas*):ab,ti OR (stomach NEAR/5 cancer*):ab,ti OR (gastric NEAR/5 cancer*):ab,ti OR (stomach NEAR/5 carcin*):ab,ti OR (gastric NEAR/5 carcin*):ab,ti OR (stomach NEAR/5 tumo*):ab,ti OR (gastric NEAR/5 tumo*):ab,ti OR (stomach NEAR/5 malig*):ab,ti OR (gastric NEAR/5 malig*):ab,ti AND ('lymphadenectomy'/exp OR 'lymphadenectomy':ab,ti OR 'lymph node excision'/exp OR 'lymph node excision':ab,ti OR ‘lymph node dissection’:ab,ti)) AND ([cochrane review]/lim OR [systematic review]/lim OR [controlled clinical trial]/lim OR [randomized controlled trial]/lim OR [meta analysis]/lim) 378

Limit 2008-2015 Eng Dutch German: 189

 

Cochrane 20 nov 2015

 

#1 ((stomach or gastric) and (neoplas* or cancer$ or tumo* or carcin* or metasta* or malig*)):ti,ab 3657

#2 MeSH descriptor: [Stomach Neoplasms] explode all trees 1771

#3 #1 OR #2 3933

#4 MeSH descriptor: [Lymph Node Excision] explode all trees1211

# 5 lymphadenectom*:ti,ab 643

#6 lymph:ti,ab AND (node: ti,ab AND (excision:ti,ab OR dissection:ti,ab) 821

#7 #4 OR #5 OR #6 2023

#8 #3 AND #7 269

Limit 2008-2015 137

137 :       CDSR: 3

                DARE : 31

                Central : 103

               

 

Methodology report

RL Maag PICO 7

 

1   KEY QUESTION

Wat zijn de gewenste en ongewenste effecten van beperkte lymfeklierdissectie in vergelijking met uitgebreide lymfeklierdissectie bij patiënten met in opzet curatief te behandelen maagcarcinoom (bij totale resectie)?

 

P Patiënten met in opzet curatief te behandelen maagcarcinoom (cT0-4N0-3M0).

I Beperkte/limited (D1) lymfeklierdissectie

C Uitgebreide/extended (D2,D3,D4) lymfeklierdissectie

O Overall survival, locoregional recurrence, disease free survival, postoperatieve mortaliteit, reoperaties, naadlekkage, pneumonie en algemene postoperatieve complicaties

 

 

2   GOLDEN HITS

#

Ref

In- or exclusion

Comment

1

El-Sedfy A, Dixon M, Seevaratnam R, Bocicariu A, Cardoso R, Mahar A, Kiss A, Helyer L, Law C, Coburn NG. Personalized Surgery for Gastric Adenocarcinoma: A Meta-analysis of D1 versus D2 Lymphadenectomy. Ann Surg Oncol. 2015 Jun;22(6):1820-7. doi: 10.1245/s10434-014-4168-6. Epub 2014 Oct 28.

exclude

Systematic review not included since no statification on geography

2

Jiang L, Yang KH, Chen Y, Guan QL, Zhao P, Tian JH, Wang Q. Systematic review and meta-analysis of the effectiveness and safety of extended lymphadenectomy in patients with resectable gastric cancer. Br J Surg. 2014 May;101(6):595-604. doi: 10.1002/bjs.9497. Epub 2014 Mar 25.

Exclude

Systematic review not included since no statification on geography

3

Songun I, Putter H, Meershoek-Klein Kranenbarg E, et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomized nationwide D1D2 trial. Lancet Oncology 2010; 11(5):439-449.

Include

 

4

Degiuli M, Sasako M, Ponti A, et al. Randomized clinical trial comparing survival after D1 or D2 gastrectomy for gastric cancer. Br J Surg 2014; 101(2):23-31.

Include

 

5

Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, Hiratsuka M, Tsujinaka T, Kinoshita T, Arai K, Yamamura Y, Okajima K; Japan Clinical Oncology Group. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008 Jul 31;359(5):453-62.

Exclude

Comparison D2 vs D2 PAND

6

Memon MA, Subramanya MS, Khan S, Hossain MB, Osland E, Memon B. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Ann Surg. 2011;253(5):900-11.

exclude

Systematic review not included since no statification on geography

7

McCulloch P, Nita ME, Kazi H, Gama-Rodrigues JJ. WITHDRAWN: Extended versus limited lymph nodes dissection technique for adenocarcinoma of the stomach. Cochrane Database Syst Rev. 2012 Jan 18;1:CD001964.

Include, however withdrawn

 

 

3   SEARCH STRATEGY

The searches were run on 20 nov 2015. Pubmed Medline, Embase, Cochrane (CDSR,DARE, Central) were searched. Detailed search strings are given below. The searches were limited to 2008-2015, English, Dutch and German. Study types: systematic reviews, meta-analysis and RCTs.

4   SEARCH RESULTS

The Medline search yielded  681 hits, while  the search in Embase yielded 189 hits, Cochrane yielded 137 hits.

 

After merging the search files into one file and removal of the duplicates 974 records were screened on title and abstract. Of these 923 were excluded. The most important reasons for exclusion was that studies were

  1. Patient population
  2. InterventionOf the remaining 51 studies, the full text was retrieved. Based on the full text, an additional 48 studies were excluded. Table 4.1 provides an overview of the studies included in the full text screening.
  3.  

4.1   Table of references for full text screening

 

#

Reference

In- or exclusion

Comment

1

Barreto SG, Shukla PJ. Nodal dissection for gastric cancer. The New England journal of medicine. 2008;359(22):2392; author reply 3.#http://www.nejm.org/doi/pdf/10.1056/NEJMc081856

Exclude

Letter to editor

2

Batista TP, Martins MR. Lymph node dissection for gastric cancer: a critical review. Oncology reviews. 2012;6(1):e12.#http://www.oncologyreviews.org/index.php/or/article/download/oncol.2012.e12/pdf

Exclude

Narrative review

3

Bischof DA, Swallow CJ, Stotland PK, et al. Incorporation of laparoscopic D2 dissection into the management of gastric adenocarcinoma (GCa) in a community-based setting. Journal of Clinical Oncology. 2012;30(4).#http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L71011348

Exclude

Conference abstract

4

Bouras G, Lee SW, Nomura E, et al. Comparative analysis of station-specific lymph node yield in laparoscopic and open distal gastrectomy for early gastric cancer. Surgical laparoscopy, endoscopy & percutaneous techniques. 2011;21(6):424-8

Exclude

Laparoscopic vs open surgery

5

Brar SS, Seevaratnam R, Cardoso R, et al. A systematic review of spleen and pancreas preservation in extended lymphadenectomy for gastric cancer. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2012;15 Suppl 1:S89-99

Exclude

systematic review of the evidence for preservation of the spleen and pancreas in extended lymphade-

nectomy during surgical therapy for gastric cancer.

6

Cao X, Wang Q, Abdikarim I, et al. Clinical application of fast track surgery with laparoscopic-assisted gastrectomy for advanced gastric cancer. Journal of Gastroenterology and Hepatology (Australia). 2014;29:272

Exclude

Conference abstract

7

Chen XZ, Hu JK, Zhou ZG, et al. Meta-analysis of effectiveness and safety of D2 plus para-aortic lymphadenectomy for resectable gastric cancer. Journal of the American College of Surgeons. 2010;210(1):100-5

Exclude

D2 vs D2+PALD

8

Cheng LY, Xie ZY, Dai GR, et al. [Preliminary experiences of application of sentinel lymph node navigation technique in early gastric cancer]. Zhonghua wai ke za zhi [Chinese journal of surgery] [Internet]. 2008; 46(14):[1076-9 pp.]. # http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/092/CN-00688092/frame.html

Exclude

Sentinel node biopsy

9

de Steur WO, Hartgrink HH, Dikken JL, et al. Quality control of lymph node dissection in the Dutch Gastric Cancer Trial. The British journal of surgery. 2015;102(11):1388-93

include

 

10

Degiuli M. Effectiveness of D2 gastrectomy for lymph node positive and advanced gastric cancer: Survival results of the Italian Gastric Cancer Study Group (IGCSG) randomized surgical trial on D1 versus D2 dissection for gastric carcinoma. Journal of clinical oncology [Internet]. 2013; 31(15 suppl. 1).

Exclude

Conference abstract

11

Degiuli M, Sasako M, Ponti A, et al. Randomized clinical trial comparing survival after D1 or D2 gastrectomy for gastric cancer. The British journal of surgery. 2014;101(2):23-31

Include

D1 vs D2 (IGCSG-R01)

12

El-Sedfy A, Dixon M, Seevaratnam R, et al. Personalized Surgery for Gastric Adenocarcinoma: A Meta-analysis of D1 versus D2 Lymphadenectomy. Annals of surgical oncology. 2015;22(6):1820-7

Exclude

Systematic review not included since no statification on geography

13

Fujimura T, Nakamura K, Oyama K, et al. Selective lymphadenectomy of para-aortic lymph nodes for advanced gastric cancer. Oncology reports. 2009;22(3):509-14

Exclude

Observational study

14

Galizia G, Lieto E, De Vita F, et al. Modified versus standard D2 lymphadenectomy in total gastrectomy for nonjunctional gastric carcinoma with lymph node metastasis. Surgery. 2015;157(2):285-96

Include

D1+ vs D2

15

He W, Tu J, Huo Z, et al. Surgical interventions for gastric cancer: a review of systematic reviews. International journal of clinical and experimental medicine. 2015;8(8):13657-69

exclude

Narrative review

16

Hu JK, Yang K, Zhang B, et al. D2 plus para-aortic lymphadenectomy versus standardized D2 lymphadenectomy in gastric cancer surgery. Surgery today. 2009;39(3):207-13.#http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L354324507

Exclude

D2 PALD vs D2

17

Imamura H, Kurokawa Y, Kawada J, et al. Influence of bursectomy on operative morbidity and mortality after radical gastrectomy for gastric cancer: results of a randomized controlled trial. World journal of surgery. 2011;35(3):625-30

Exclude

D2 Bursectomy vs D2 non bursectomy

18

Iqbal N, Lovegrove RE, Tilney HS, et al. A comparison of pancreaticoduodenectomy with extended pancreaticoduodenectomy: a meta-analysis of 1909 patients. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2009;35(1):79-86

Exclude

Pancreaticoduodenectomy vs extended pancreaticoduodenectomy

19

Irino T, Hiki N, Nunobe S, et al. Subtotal gastrectomy with limited lymph node dissection is a feasible treatment option for patients with early gastric stump cancer. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2014;18(8):1429-33

Exclude

Gastric stump cancer

20

Jiang L, Yang KH, Guan QL, et al. Survival and recurrence free benefits with different lymphadenectomy for resectable gastric cancer: a meta-analysis. Journal of surgical oncology. 2013;107(8):807-14

Exclude

Systematic review not included since no statification on geography

21

Jiang L, Yang KH, Chen Y, et al. Systematic review and meta-analysis of the effectiveness and safety of extended lymphadenectomy in patients with resectable gastric cancer. The British journal of surgery. 2014;101(6):595-604.#http://www.ncbi.nlm.nih.gov/pubmed/24668465

Exclude

Systematic review not included since no statification on geography

22

Kawamura H, Homma S, Yokota R, et al. Inspection of safety and accuracy of D2 lymph node dissection in laparoscopy-assisted distal gastrectomy. World journal of surgery. 2008;32(11):2366-70

Exclude

LADG vs ODG

23

Kim YW, Park YK, Yoon HM, et al. Result of clinical study on feasibility of laparoscopy-assisted D2 distal gastrectomy to treat advanced gastric cancer (COACT-1001). Journal of clinical oncology [Internet]. 2013; 31

Exclude

Conference abstract

24

Kim HI, Hur H, Kim YN, et al. Standardization of D2 lymphadenectomy and surgical quality control (KLASS-02-QC): a prospective, observational, multicenter study [NCT01283893]. BMC cancer. 2014;14:209.#http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000001/pdf/1471-2407-14-209.pdf

Exclude

Observational study

25

Kim J, Eom BW, Nam BH, et al. ADDICT-A multicenter randomized clinical trial of D1+ versus D2 distal gastrectomy for stage IB & II advanced gastric cancer: Design and rationale. European journal of surgical oncology [Internet]. 2014; 40(11):[S162 p.]. # http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/036/CN-01088036/frame.html

Exclude

Conference abstract

26

Kurokawa Y, Sasako M, Sano T, et al. Functional outcomes after extended surgery for gastric cancer. The British journal of surgery. 2011;98(2):239-45.

Exclude

D2 lymphadenectomy

alone vs D2 lymphadenectomy plus PAND

27

Liakakos T, Patapis P, Charalambopoulos A, et al. Laparoscopic D2 gastrectomy: time for a randomized trial. World journal of surgery. 2009;33(7):1542-3; author reply

Exclude

Author reply

28

Liu N, Niu Z, Niu W, et al. Intraoperative sentinel lymph node mapping guides laparoscopic-assisted distal gastrectomy for distal gastric cancer. International journal of clinical and experimental medicine. 2015;8(4):5760-6.#http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4483915/pdf/ijcem0008-5760.pdf

Exclude

Sentinel lymph node mapping

29

Lustosa SA, Saconato H, Atallah AN, et al. Impact of extended lymphadenectomy on morbidity, mortality, recurrence and 5-year survival after gastrectomy for cancer. Meta-analysis of randomized clinical trials. Acta cirurgica brasileira / Sociedade Brasileira para Desenvolvimento Pesquisa em Cirurgia. 2008;23(6):520-30

Exclude

Systematic review not included since no statification on geography

30

McCulloch P, Nita ME, Kazi H, et al. WITHDRAWN: Extended versus limited lymph nodes dissection technique for adenocarcinoma of the stomach. The Cochrane database of systematic reviews. 2012;1:Cd001964

Exclude

Withdrawn

31

Memon MA, Subramanya MS, Khan S, et al. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Annals of surgery. 2011;253(5):900-11

Exclude

Systematic review not included since no statification on geography

32

Mocellin S, McCulloch P, Kazi H, et al. Extent of lymph node dissection for adenocarcinoma of the stomach. The Cochrane database of systematic reviews. 2015;8:

Exclude

Systematic review not included since no statification on geography

33

Mocellin S, Nitti D. Lymphadenectomy extent and survival of patients with gastric carcinoma: a systematic review and meta-analysis of time-to-event data from randomized trials. Cancer treatment reviews. 2015;41(5):448-54

Exclude

Systematic review not included since no statification on geography

34

Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. The New England journal of medicine. 2008;359(5):453-62

Exclude

D2 PAND vs D2

35

Schmidt B, Chang KK, Maduekwe UN, et al. D2 lymphadenectomy with surgical ex vivo dissection into node stations for gastric adenocarcinoma can be performed safely in Western patients and ensures optimal staging. Annals of surgical oncology. 2013;20(9):2991

Exclude

Retrospective chart review

36

Schmidt B, Yoon SS. D1 versus D2 lymphadenectomy for gastric cancer. Journal of surgical oncology. 2013;107(3):259-64

Exclude

Narrative review

37

Seevaratnam R, Bocicariu A, Cardoso R, et al. A meta-analysis of D1 versus D2 lymph node dissection. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2012;15 Suppl 1:S60-9.

Exclude

Systematic review not included since no statification on geography

38

Songun I, Putter H, Kranenbarg EM, et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. The Lancet Oncology. 2010;11(5):439-49

Include

Dutch D1D2 trial

39

Strong VE, Yoon SS. Extended lymphadenectomy in gastric cancer is debatable. World journal of surgery. 2013;37(8):1773-7

Exclude

Narrative review

40

Tanizawa Y, Terashima M. Lymph node dissection in the resection of gastric cancer: review of existing evidence. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2010;13(3):137-48

Exclude

Systematic review not included since no statification on geography

41

Tokunaga M, Hiki N, Fukunaga T, et al. Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection following standardization--a preliminary study. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2009;13(6):1058-63a

Exclude

Observational study

42

Vallbohmer D, Oh DS, Peters JH. The role of lymphadenectomy in the surgical treatment of esophageal and gastric cancer. Current problems in surgery. 2012;49(8):471-515

Exclude

Narrative review

43

Verlato G, Giacopuzzi S, Bencivenga M, et al. Problems faced by evidence-based medicine in evaluating lymphadenectomy for gastric cancer. World journal of gastroenterology : WJG. 2014;20(36):12883-91.#http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4177470/pdf/WJG-20-12883.pdf

Exclude

Narrative review

44

Wang Z, Chen JQ, Cao YF. Systematic review of D2 lymphadenectomy versus D2 with para-aortic nodal dissection for advanced gastric cancer. World journal of gastroenterology : WJG. 2010;16(9):1138-49

exclude

D2 PAND vs D2

45

Wei JM, Shiraishi N, Goto S, et al. Laparoscopy-assisted distal gastrectomy with D1+beta compared with D1+alpha lymph node dissection. Surgical endoscopy. 2008;22(4):955-60.

Exclude

D1+beta vs D1+alpha?

46

Yang SH, Zhang YC, Yang KH, et al. An evidence-based medicine review of lymphadenectomy extent for gastric cancer. American journal of surgery. 2009;197(2):246-51

Exclude

Systematic review not included since no statification on geography

47

Yao XX, Yan C, Yan M, et al. [A comparative study on the efficacy of spleen-preserving modified D2 radical gastrectomy and D2 radical gastrectomy with splenectomy]. Zhonghua wei chang wai ke za zhi [Chinese journal of gastrointestinal surgery] [Internet]. 2010; 13(2):[111-4 pp.].

Exclude

Chinese

48

Yonemura Y, Wu CC, Fukushima N, et al. Randomized clinical trial of D2 and extended paraaortic lymphadenectomy in patients with gastric cancer. International journal of clinical oncology. 2008;13(2):132-7

Exclude

D2 vs extended D2

49

Yoon SS, Yang HK. Lymphadenectomy for gastric adenocarcinoma: should west meet east? The oncologist. 2009;14(9):871-82

Exclude

Narrative review

50

Zhang C, He Y, Schwarz RE, et al. Evaluation of para-aortic nodal dissection for locoregionally advanced gastric cancer with 1-3 involved para-aortic nodes. Chinese medical journal. 2014;127(3):435-41

Exclude

Chart review

51

Zheng B, Ma B, Yang K, et al. Meta-analysis of randomized controlled trials comparing D2 and D4 lymphadenectomy for gastric cancer. European Surgery - Acta Chirurgica Austriaca. 2011;43(5):255-61

Exclude

Systematic review not included since no statification on geography

 

Search syntax are detailed in appendix

 

Appendix

 

Pubmed Medline

20 nov 2015

 

Patients:

 

#1        "Stomach Neoplasms"[Mesh]

#2        stomach[tiab] AND neoplas*[tiab]

#3        stomach[tiab] AND cancer*[tiab]

#4        stomach[tiab] AND carcin*[tiab]

#5        stomach[tiab] AND tumo*[tiab]

#6        stomach[tiab] AND malig*[tiab]

#7        gastric[tiab] AND neoplas*[tiab]

#8        gastric[tiab] AND cancer*[tiab]

#9        gastric[tiab] AND carcin*[tiab]

#10       gastric[tiab] AND tumo*[tiab]

#11       gastric[tiab] AND malig*[tiab]

#12       Stomach[Mesh]

#13       neoplas*[tiab] OR cancer*[tiab] OR carcin*[tiab] OR tumor*[tiab] OR tumour*[tiab]] OR malig*[tiab] OR "Neoplasms"[Mesh]

#14       #12 AND #13

#15       #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #10 OR #11 OR #14

 

((((((((("Stomach Neoplasms"[Mesh]) OR ((stomach[tiab] AND neoplas*[tiab]))) OR ((stomach[tiab] AND cancer*[tiab]))) OR ((stomach[tiab] AND carcin*[tiab]))) OR ((stomach[tiab] AND malig*[tiab]))) OR ((gastric[tiab] AND neoplas*[tiab]))) OR ((gastric[tiab] AND cancer*[tiab]))) OR ((gastric[tiab] AND carcin*[tiab))) OR ((gastric[tiab] AND malig*[tiab]))) OR ((gastric[tiab] AND (tumor*[tiab] OR tumour*[tiab])) OR ((stomach[tiab] AND (tumor*[tiab] OR tumour*[tiab])))) OR ((Stomach[Mesh]) AND ((neoplas*[tiab] OR cancer*[tiab] OR carcin*[tiab] OR tumor*[tiab] OR tumour*[tiab] OR malig*[tiab] OR "Neoplasms"[Mesh]))) 121490

Intervention:

#16 Lymphadenectom*[tiab] 13162

#17 "Lymph Node Excision"[Mesh] 37932

#18 lymph[tiab] AND node[tiab] AND (excision[tiab] OR dissection[tiab]) 4436

#19 #16 OR #17 OR #18

"Lymph Node Excision"[Mesh] OR Lymphadenectom*[tiab] OR (lymph[tiab] AND node[tiab] AND (excision[tiab] OR dissection[tiab])) 52789

 

P AND I: 5040

 

RCT-filter

(randomized controlled trial[pt] OR controlled clinical trial[pt] OR randomized[tiab] OR placebo[tiab] OR drug therapy[sh] OR randomly[tiab] OR trial[tiab] OR groups[tiab]) 3689106

P AND I and RCT: 1658

Sys rev filter

((review[tiab] OR "Review"[Publication Type] OR "Meta-Analysis as Topic"[Mesh] OR meta-analysis[tiab] OR "Meta-Analysis "[Publication Type]) NOT ("Letter"[Publication Type] OR "Editorial"[Publication Type] OR "Comment"[Publication Type])) NOT ("Animals"[Mesh] NOT ("Animals"[Mesh] AND "Humans"[Mesh])) 2344508

P AND I and Sys Rev: 914

P.I SysRev AND RCT: 2256

Limit 2008-2015, Eng Dutch German: 861

 

Embase 20 nov 2015

Patients

'stomach cancer'/exp OR (stomach NEAR/5 neoplas*):ab,ti OR (gastric NEAR/5 neoplas*):ab,ti OR (stomach NEAR/5 cancer*):ab,ti OR (gastric NEAR/5 cancer*):ab,ti OR (stomach NEAR/5 carcin*):ab,ti OR (gastric NEAR/5 carcin*):ab,ti OR (stomach NEAR/5 tumo*):ab,ti OR (gastric NEAR/5 tumo*):ab,ti OR (stomach NEAR/5 malig*):ab,ti OR (gastric NEAR/5 malig*):ab,ti  121,167

 

Intervention:

'lymphadenectomy'/exp OR 'lymphadenectomy':ab,ti OR 'lymph node excision'/exp OR 'lymph node excision':ab,ti OR ‘lymph node dissection’:ab,ti 59,792

 

P AND I:

'stomach cancer'/exp OR (stomach NEAR/5 neoplas*):ab,ti OR (gastric NEAR/5 neoplas*):ab,ti OR (stomach NEAR/5 cancer*):ab,ti OR (gastric NEAR/5 cancer*):ab,ti OR (stomach NEAR/5 carcin*):ab,ti OR (gastric NEAR/5 carcin*):ab,ti OR (stomach NEAR/5 tumo*):ab,ti OR (gastric NEAR/5 tumo*):ab,ti OR (stomach NEAR/5 malig*):ab,ti OR (gastric NEAR/5 malig*):ab,ti AND ('lymphadenectomy'/exp OR 'lymphadenectomy':ab,ti OR 'lymph node excision'/exp OR 'lymph node excision':ab,ti OR ‘lymph node dissection’:ab,ti ) 5736

 

 

Sys Rev,RCT filter::

('stomach cancer'/exp OR (stomach NEAR/5 neoplas*):ab,ti OR (gastric NEAR/5 neoplas*):ab,ti OR (stomach NEAR/5 cancer*):ab,ti OR (gastric NEAR/5 cancer*):ab,ti OR (stomach NEAR/5 carcin*):ab,ti OR (gastric NEAR/5 carcin*):ab,ti OR (stomach NEAR/5 tumo*):ab,ti OR (gastric NEAR/5 tumo*):ab,ti OR (stomach NEAR/5 malig*):ab,ti OR (gastric NEAR/5 malig*):ab,ti AND ('lymphadenectomy'/exp OR 'lymphadenectomy':ab,ti OR 'lymph node excision'/exp OR 'lymph node excision':ab,ti OR ‘lymph node dissection’:ab,ti)) AND ([cochrane review]/lim OR [systematic review]/lim OR [controlled clinical trial]/lim OR [randomized controlled trial]/lim OR [meta analysis]/lim) 378

Limit 2008-2015 Eng Dutch German: 189

 

Cochrane 20 nov 2015

 

#1 ((stomach or gastric) and (neoplas* or cancer$ or tumo* or carcin* or metasta* or malig*)):ti,ab 3657

#2 MeSH descriptor: [Stomach Neoplasms] explode all trees 1771

#3 #1 OR #2 3933

#4 MeSH descriptor: [Lymph Node Excision] explode all trees1211

# 5 lymphadenectom*:ti,ab 643

#6 lymph:ti,ab AND (node: ti,ab AND (excision:ti,ab OR dissection:ti,ab) 821

#7 #4 OR #5 OR #6 2023

#8 #3 AND #7 269

Limit 2008-2015 137

137 :       CDSR: 3

                DARE : 31

                Central : 103