remains the mainstay in the treatment of gastric cancer. Complete
resection of the tumor (R0), whenever feasible, has been established
standard care. An R0 resection involves the removal of the primary
tumor with partial or total gastrectomy. Whether however, resection
of the stomach should be combined with limited (D0/1) or extended
(D2) node dissection for a “true” R0 resection and
better survival still remains strongly controversial.
D2 gastrectomy has been standard in Japan on the basis of excellent
results, which however are based on retrospective reports. This
Japanese surgical model has not yet incorporated into routine
clinical practice in the West because primarily of two previous
negative European randomized controlled trials (RCTs).
Most recently several RCTs have provided scientific evidence
for the safety of D2 gastrectomy, provided that the surgical
procedure is performed by high-volume surgeons. However, to
assess the effects of this surgical technique on long-term survival
is extremely challenging. A recent proof-of-concept for a N2-stage-specific
survival benefit with D2 gastrectomy highlights this controversial
Is the new data sufficient to support a move from D1 to D2
gastrectomy outsides Japan?