Over the last three decades extend of lymphadenectomy for resectable gastric cancer has been controversial. D2 lymphadenectomy has been the standard surgery for nonmetastatic gastric cancer in Japan .
However, in the West in an absence of evidence from randomized controlled trials (RCT), D2 surgery has not been the standard approach.
Recently, Sasako et al  published in the NEJM the results of a Japanese RCT comparing D2 lymphadenectomy alone or D2 plus para-aortic lymph nodal dissection (PAND, for advanced stages II/III gastric cancer.
Here, these data are analyzed . What are the clinical implications of this study in the USA and Europe ?