Perioperative and adjuvant treatments for gastric cancer. Definitive new standards of care or are we still on the way

n Western countries, the 5-year survival rate for patients treated with surgery alone is significantly poorer than that achieved stage by stage in Japanese series. This difference has been widely debated and was thought to be associated with extended D2 or D3 lymphadenectomies – which include excision of the second or third lymph node stations – systematically performed by Japanese surgeons in gastric carcinoma resections. Two prospective randomised studies (the MRC [1] and Dutch [2] trials) were carried out in Europe to compare D2 gastric resections with more limited D1 lymphadenectomies, more usually performed by Western surgeons. These trials expected to demonstrate in the D2 lymphadenectomy group a decrease in regional failure and avoid the stage migration phenomenon, which probably accounted for the better survival observed in Japanese patients. However, these trials did not confirm a superior survival in the D2 gastric resection group, although further analysis showed that pancreatectomies and splenectomies carried out in D2 lymphadenectomies strongly increased morbidity and mortality,