The surgical treatment of gastric cancer with special reference to systematic lymph node dissection

Extended lymph node dissection is a controversial issue in the treatment of gastric cancer. In Japan and in several institutions in West Germany, this has become the standard treatment for patients operated on with curative intent. In most other countries, extended lymph node dissection is only performed incidentally or as a subject of trial. Several Japanese [1–4] as well as German [5–8] papers have described the essentials of lymph node dissection. There is no conclusive evidence, however, that this radical approach will give a better prognosis. The question remains if radical lymph node dissection is not merely a way of improving classification, the so-called stage migration phenomenon [9]. By finding involved lymph nodes at more distant locations one could argue that these would not have been found if less meticulous examination would have taken place. In this way, different stages of disease with different prognosis would have been compared. Prospective randomized studies are currently in progress (MRC trial England, Dutch Gastric Cancer Trial in cooperation with the National Cancer Center in Tokyo), but the introduction of radical lymph node dissection in Japan in 1962 was a bold move of the Japanese Research Society for Gastric Cancer (J.R.S.G.C.), based upon retrospective analysis and personal experiences [10].