Results of extended lymphadenectomy in the surgical treatment of gastric carcinoma. Considerations on data from the literature

In the surgical response to gastric carcinoma the use of extensive lymphadenectomy (D2) is still being debated. In Japan D2 is the operation of choice and the numerous selected case studies emphasize better long term survival at all stages with this operation. In the West D2 has not obtained the same approval, besides which it is burdened by higher postoperative morbidity and mortality. The important prospective non-selective trials have not shown differences in the general rates of survival between D1 and D2: the analysis of subgroups, instead, shows better results for stages II and IIIA. The distal splenopancreasectomy and the lack of experience of the surgeons worsen the results of D2. Therefore, when reanalyzing the results of the trials in the light of this information a difference is obtained in the rates of survival in favour of D2 for a wider category of patients. The age of the patient necessitates strict preoperative selection. In some selected cases D2 may be performed; for the majority of older patients the operation of choice is D1 extended to the celiac lymph nodes.