Current Opinion of Lymphadenectomy for Gastric Cancer

The extent of lymphadenectomy for adenocarcinoma of stomach is still debated. Japanese surgeons routinely perform more extended (D2) lymph node dissection, based on their retrospective reports of large population sets. However, randomized controlled trials have shown no evidence of survival benefit for D2 surgery by Western surgeons, but evidence of increased operative morbidity and mortality. Recently, modified radical lymphadenectomy, less extended than D2 but more extended than D1, has been recommended for some T1 neoplasms by the Japanese Gastric Cancer Association in the new gastric cancer treatment guidelines. Because lymph node metastasis is not frequent for early gastric cancer, standard D2 lymph node dissection may be unnecessary for most patients in this group. Hence, sentinel lymph node biopsy is introduced for gastric cancer in order to reduce extent of lymphadenectomy. On the other hand, a super-extended (D3) lymphadenectomy is undergoing clinical trials for advanced gastric cancer. In this review paper, we summarize these changes and current opinions on lymphadenectomy for gastric cancer.