Rational extent of lymphadenectomy for local advanced gastric cancer

Abstract

The rational extent of lymphadenectomy for local advanced gastric cancer is a controversial issue in the past decades. D2 radical gastrectomy is recommended as a worldwide standard procedure for local advanced gastric cancer based on the international publications of randomized clinical trials. Because of the limitations of design in the randomized clinical trial (JCOG9501) , the significance of No. 16 lymph node dissection for patients with T4 and N3 stage of gastric cancer which is very common in China is not very clear. The clinical efficacies of splenectomy for complete resection of No. 10 lymph node need to be confirmed by the final result of the randomized clinical trial (JCOG0110). Although positive No. 14v and No. 13 lymph nodes metastasis are defined as distal metastasis (M1) according to the Japanese gastric cancer treatment guidelines 2010 (ver. 3) , D2 radical gastrectomy plus No. 14v and No. 13 lymphadenectomy should be applied to the potential patients with positive No.6 lymph node metastasis or distal advanced gastric cancer with duodenal invasion. The number of lymph node dissection and extra-nodal soft tissue dissection are significantly associated with the prognosis of patients. Key words: Gastric neoplasms; Lymph node dissection