Current best practices and rationalistic perspectives in causation-based prevention, early detection and multidisciplinary treatment of breast and gastric cancer


Gastric & Breast Cancer
DOI: 10.2122/gbc.2004.0035

REVIEW

New Data for Lymphadenectomy in Gastric Cancer:
Is the Debate Over?


Theodore Liakakos M.D., Michael Fatouros, M.D., Kitty Pavlaki M.D, Gabriel Karatzas M.D.
Abstract

Surgery 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 topic.

Is the new data sufficient to support a move from D1 to D2 gastrectomy outsides Japan?

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Online ISSN : 1109 - 7647
   Print ISSN : 1109 - 7655

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last update: 22 May 2003