Abstract
Gastric cancer is one of the most common causes of cancer-related death worldwide. Surgical resection with lymph node dissection is the only potentially curative therapy for gastric cancer. However, the appropriate extent of lymph node dissection accompanied by gastrectomy for cancer remains controversial. In East Asian countries, especially in Japan and Korea, D2 lymph node dissection has been regularly performed as a standard procedure. In Western countries, surgeons perform gastrectomy with D1 dissection only because D2 is associated with high mortality and morbidity compared to those associated with D1 alone but does not improve the 5-year survival rate. However, more recent studies have demonstrated that western surgeons can be trained to perform D2 lymphadenectomies on western patients with a lower morbidity and mortality. When extensive D2 lymph node dissection is preformed safely, there may be some benefit to D2 dissection even in western countries. In this paper, we present an update on the current literature regarding the extent of lymphadenectomy for advanced gastric cancer.
Highlights
Gastric cancer is one of the most common causes of death worldwide [1]
The prognosis of patients with advanced gastric cancer has improved with the introduction of effective chemotherapy [2] or adjuvant radiotherapy [3], surgical resection remains the primary therapeutic modality for curable advanced cancer
Most Western surgeons perform gastrectomy with only D1 dissection, because D1 was associated with less mortality and morbidity than D2 in prospective randomized trials preformed in the Netherland and the UK concluded that there was no survival benefit for D2 over D1 lymph node dissection [5, 6]
Summary
Gastric cancer is one of the most common causes of death worldwide [1]. the prognosis of patients with advanced gastric cancer has improved with the introduction of effective chemotherapy [2] or adjuvant radiotherapy [3], surgical resection remains the primary therapeutic modality for curable advanced cancer. Most Western surgeons perform gastrectomy with only D1 dissection, because D1 was associated with less mortality and morbidity than D2 in prospective randomized trials preformed in the Netherland and the UK concluded that there was no survival benefit for D2 over D1 lymph node dissection [5, 6]. There were significant problems with these studies, including a high morbidity and mortality rate in the D2 group associated with inadequate surgical training, with inadequate dissection of D2 and with the frequent performance of distal pancreatectomy and splenectomy in the D2 group, which is considered unnecessary [7]. More recent studies have demonstrated that western surgeons at experienced centers can be trained to perform D2 gastrectomy for selected western patients with low morbidity and mortality [8,9,10]. We describe an update on the current literature regarding the extent of lymphadenectomy for advanced gastric cancer
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