BACKGROUND: Current guidelines indicate that D2 resection is the standard of care for @entity1 with locally advanced @entity356 . To assess the impact of quality assurance of lymph node removal, non-compliance and contamination in the @entity14169 study arms of the Dutch @entity356 Trial were investigated with respect to recurrence and survival. METHODS: The location and numbers of lymph nodes detected at pathological investigation in the Dutch @entity356 Trial were compared according to the guidelines of the Japanese Research Society for the study of @entity356 . Non-compliance was defined as inadequate removal of lymph node stations. Contamination was defined as lymph nodes removed outside the intended level of resection. The dissection groups @entity14169 were divided into non-compliance, compliance and contamination categories. Long-term overall survival was calculated for minor (2 or fewer lymph nodes) and major (more than 2 lymph nodes) non-compliance and contamination in the @entity14169 group, using Kaplan-Meier plots. RESULTS: Some 1078 @entity1 were included, of whom 711 with potentially curative surgical resections were evaluated. Overall non-compliance was 80  5 per cent in the D1 and 81  6 per cent in the D2 group. Major non-compliance occurred in 15  3 per cent of the D1 and 26  0 per cent of the D2 group. Major contamination hardly occurred. Overall 15-year survival rates in the randomized groups were 21  2 per cent (D1) and 29  0 per cent (D2) (P   =   0  351). After exclusion of @entity1 with major non-compliance and/or major contamination, survival rates were 23  2 per cent (319 @entity1 ) and 32  6 per cent (245) respectively (P   =   0  261). Where there was major non-compliance, survival rates in the D1 (58 @entity1 ) and D2 (86) groups were 10 and 17 per cent respectively (P   =   0  302). Survival in the D2 compliant   +   contaminated group (139 @entity1 ) was significantly better than that in the D1 group without contamination (282): 35  7 versus 19  9 per cent (P   =   0  041). In the D2 group, there was a significant difference in survival between contaminated (95 @entity1 ) and non-contaminated (236) groups: 39 versus 25  1 per cent (P   =   0  041). CONCLUSION: Non-compliance in the D2 dissection group may have obscured a significant difference in survival between the randomized groups. A D2 dissection with contamination was associated with the best survival, suggesting that extended D2 lymph node dissections improve survival.

Quality control of lymph node dissection in the Dutch XXXX Trial.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity14169 :: ('25802;28503', 'Gene') :: ['D1 and D2'] @entity356 :: ('MESH:D013274', 'Disease') :: ['gastric cancer', 'Gastric Cancer']
@entity356 :: (MESH:D013274,Disease) :: ['Gastric Cancer']
