Randomized clinical trial of D2 and extended paraaortic lymphadenectomy in patients with gastric cancer
Related Experiment Video
Updated: Jul 5, 2026
Laparoscopic Radical Gastrectomy for Remnant Gastric Cancer
Published on: October 31, 2025
Yutaka Yonemura1, Cheng-Chung Wu, Norimasa Fukushima
1Gastric Surgery Division and Peritoneal Dissemination Program, Shizuoka Cancer Center, 1007 Shimo-nagakubo, Nagaizumi-machi, Shizuoka, 411-8777, Japan. y.yonemura@scchr.jp
Background:
The survival of patients with advanced gastric cancer after D2 dissection is still poor. Asian surgeons have proposed a more radical lymph node dissection, designated as D4 dissection, where paraaortic lymph nodes are removed in combination with D2 dissection. To evaluate the survival benefit of D4 dissection, a multi-institutional randomized trial of D2 vs D4 gastrectomy was conducted.
Methods:
Patients enrolled in the study had potentially curable gastric adenocarcinoma at an advanced stage. Patients were randomized to undergo either D2 or D4 gastrectomy.
Results:
Two hundred and ninety-three patients were registered and 269 patients were eligible; 135 patients were allocated to the D2 group and 134 to the D4 group. Five-year survival was 52.6% after D2 surgery and 55.0% after D4 gastrectomy. There was no significant difference in survival between the D2 and D4 groups (chi(2) = 0.064; P = 0.801). Hospital deaths occurred in 1 patients (0.7%) in the D2 group and 5 in the D4 group D4 gastrectomy is a more risky surgery than D2 dissection. Seven patients (5.2%) in the D2 and 15 (11.2%) in the D4 group died of causes other than gastric cancer recurrence. Sixty-three patients (46.7%) in the D2 group and 52 (38.8%) in the D4 group had disease recurrence.
Conclusion:
Prophylactic D4 dissection is not recommended for patients with potentially curable advanced gastric cancer.
