Lymph node dissection in curative gastrectomy for advanced gastric cancer

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.

Figures

Figure 1

Lymph node station numbers according to the Japanese classification of gastric cancer of the 14th edition reproduced form [12] with permission.

Figure 2

Lymph node dissection according to the Japanese gastric cancer treatment guideline 2010 of the 3rd edition reproduced form [14] with permission. D1 distal gastrectomy consists of LN dissection of station nos. 1, 3, 4sb, 4d, 5, 6, and 7 and D1 total gastrectomy consists of station nos. 1–6 and 7 (blue circle). Yellow circles indicate the lymph nodes that belong to D1+, and red circles indicate those to D2.