Logo of brjcancerBJC HomepageBJC Advance online publicationBJC Current IssueSubmitting an article to BJCWeb feeds
Br J Cancer. 1999 Mar; 79(9-10): 1522–1530.
PMCID: PMC2362742

Patient survival after D 1 and D 2 resections for gastric cancer: long-term results of the MRC randomized surgical trial

A Cuschieri,1 S Weeden,2 J Fielding,3 J Bancewicz,4 J Craven,5 V Joypaul,1 M Sydes,2 P Fayers,2 and for the Surgical Co-operative Group


Controversy still exists on the optimal surgical resection for potentially curable gastric cancer. Much better long-term survival has been reported in retrospective/non-randomized studies with D 2 resections that involve a radical extended regional lymphadenectomy than with the standard D 1 resections. In this paper we report the long-term survival of patients entered into a randomized study, with follow-up to death or 3 years in 96% of patients and a median follow-up of 6.5 years. In this prospective trial D 1 resection (removal of regional perigastric nodes) was compared with D 2 resection (extended lymphadenectomy to include level 1 and 2 regional nodes). Central randomization followed a staging laparotomy.

Out of 737 patients with histologically proven gastric adenocarcinoma registered, 337 patients were ineligible by staging laparotomy because of advanced disease and 400 were randomized. The 5-year survival rates were 35% for D 1 resection and 33% for D 2 resection (difference –2%, 95% CI = –12%–8%). There was no difference in the overall 5-year survival between the two arms (HR = 1.10, 95% CI 0.87–1.39, where HR > 1 implies a survival benefit to D 1 surgery). Survival based on death from gastric cancer as the event was similar in the D 1 and D 2 groups (HR = 1.05, 95% CI 0.79–1.39) as was recurrence-free survival (HR = 1.03, 95% CI 0.82–1.29). In a multivariate analysis, clinical stages II and III, old age, male sex and removal of spleen and pancreas were independently associated with poor survival. These findings indicate that the classical Japanese D 2 resection offers no survival advantage over D 1 surgery. However, the possibility that D 2 resection without pancreatico-splenectomy may be better than standard D 1 resection cannot be dismissed by the results of this trial. © 1999 Cancer Research Campaign

Keywords: gastric cancer, D 1 resection, D 2 resection, long-term survival

Full Text

The Full Text of this article is available as a PDF (123K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, van Elk P, Obertop H, Gouma DJ, Taat CW, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995 Mar 25;345(8952):745–748. [PubMed]
  • Bunt TM, Bonenkamp HJ, Hermans J, van de Velde CJ, Arends JW, Fleuren G, Bruijn JA. Factors influencing noncompliance and contamination in a randomized trial of "Western" (r1) versus "Japanese" (r2) type surgery in gastric cancer. Cancer. 1994 Mar 15;73(6):1544–1551. [PubMed]
  • Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, Cook P. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet. 1996 Apr 13;347(9007):995–999. [PubMed]
  • Fass J, Schumpelick V. Principles of radical surgery in gastric carcinoma. Hepatogastroenterology. 1989 Feb;36(1):13–17. [PubMed]
  • Griffith JP, Sue-Ling HM, Martin I, Dixon MF, McMahon MJ, Axon AT, Johnston D. Preservation of the spleen improves survival after radical surgery for gastric cancer. Gut. 1995 May;36(5):684–690. [PMC free article] [PubMed]
  • Jaehne J, Meyer HJ, Maschek H, Geerlings H, Burns E, Pichlmayr R. Lymphadenectomy in gastric carcinoma. A prospective and prognostic study. Arch Surg. 1992 Mar;127(3):290–294. [PubMed]
  • Kajitani T. The general rules for the gastric cancer study in surgery and pathology. Part I. Clinical classification. Jpn J Surg. 1981 Mar;11(2):127–139. [PubMed]
  • Maruyama K, Okabayashi K, Kinoshita T. Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg. 1987 Aug;11(4):418–425. [PubMed]
  • de Almeida JC, Bettencourt A, Costa CS, de Almeida JM. Curative surgery for gastric cancer: study of 166 consecutive patients. World J Surg. 1994 Nov-Dec;18(6):889–895. [PubMed]
  • Mine M, Majima S, Harada M, Etani S. End results of gastrectomy for gastric cancer: effect of extensive lymph node dissection. Surgery. 1970 Nov;68(5):753–758. [PubMed]
  • Nakajima T, Nishi M. Surgery and adjuvant chemotherapy for gastric cancer. Hepatogastroenterology. 1989 Apr;36(2):79–85. [PubMed]
  • Otsuji E, Yamaguchi T, Sawai K, Okamoto K, Takahashi T. End results of simultaneous pancreatectomy, splenectomy and total gastrectomy for patients with gastric carcinoma. Br J Cancer. 1997;75(8):1219–1223. [PMC free article] [PubMed]
  • Siewert JR, Böttcher K, Roder JD, Busch R, Hermanek P, Meyer HJ. Prognostic relevance of systematic lymph node dissection in gastric carcinoma. German Gastric Carcinoma Study Group. Br J Surg. 1993 Aug;80(8):1015–1018. [PubMed]
  • Smith JW, Shiu MH, Kelsey L, Brennan MF. Morbidity of radical lymphadenectomy in the curative resection of gastric carcinoma. Arch Surg. 1991 Dec;126(12):1469–1473. [PubMed]
  • Sue-Ling HM, Johnston D, Martin IG, Dixon MF, Lansdown MR, McMahon MJ, Axon AT. Gastric cancer: a curable disease in Britain. BMJ. 1993 Sep 4;307(6904):591–596. [PMC free article] [PubMed]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK


Save items

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • Cited in Books
    Cited in Books
    NCBI Bookshelf books that cite the current articles.
  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...