Treatment
of gastric cancer has been controversial. Studies
on extent of surgery have showed conflicting results
and evidence from randomized controlled trials (RCTs)
is insufficient to support treatment guidelines. Currently,
a proof1 of the concept2 that extensive D2 node dissection
results in cure a substantial proportion of N2 patients,
who have no chance of cure with D1 dissection, has
been demonstrated. However, D2 increases operative
mortality in inexperienced hands and is not superior
to D1 dissection for patients with N0 or N1 disease
[Japanese anatomical nodal classification system].3
These findings partially explain the failure of RCTs
available to demonstrate a significant overall survival
benefit. Is the emerging evidence sufficient for recommendations
on surgical treatment of gastric cancer? |
