How does extended lymphadenectomy influence practical care for patients with gastric cancer?

The recurrence and survival rates in patients with curable gastric cancer remain suboptimal. Debate on the optimal extent of lymphadenectomy for the surgical treatment of these patients is, therefore, still ongoing. A randomized, controlled trial by Sasako et al. has examined whether addition of para-aortic nodal dissection to D2 lymphadenectomy improves survival in patients with gastric cancer. The study included 523 patients who were randomly assigned either D2 lymphadenectomy or D2 lymphadenectomy and para-aortic nodal dissection. The results from this trial, whose primary end point was overall survival, demonstrated no additional benefit of lymphadenectomy beyond D2 resection. Management strategies should focus on optimal lymphadenectomy in high-volume hospitals, with evaluation of chemotherapy and radiotherapy, to achieve low surgery-related morbidity and mortality, optimal locoregional control and improved survival rates for patients with curable gastric cancer.