Quality control of radical lymphadenectomy for gastric cancer

Abstract

D2 lymphadenectomy is currently the worldwide standard operation for locally advanced gastric cancer. There were no major modifications for extent of standard lymphadenectomy in Japanese gastric cancer treatment guidelines 2014(ver.4). Prophylactic para-arotic lymphadenectomy is not recommended. Although there is no high level evidence, D2+No14v may be beneficial to patients who are suspected to harbor metastasis to No6 node, and D2+No13 lymphadenectomy may be an option in a potentially curative gastrectomy for tumors invading the duodenum. According to the finial results of JCOG1001, bursectomy is not recommended as a standard procedure for cT3/4 gastric cancer. Incidence of gastric cancer is quite high in China while overall operation level of gastric cancer is unequal. How to ensure the quality of radical gastrectomy is a recently important topic meanwhile the lymphadenectomy extent should be standard. Operational quantity per year in hospital and surgeons is considered as the final factors for the quality of radical gastrectomy. Centralization of gastric cancer surgery may be needed for the improvement of gastric cancer care in China. Education and training for the specialist are imperative for good outcomes of gastric cancer surgery. Ex vivo dissection for lymph nodes is effective method of precise staging and individual adjuvant treatment for gastric cancer patients.