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Standard D2 and modified nodal dissection for gastric adenocarcinoma
1Surgical Oncology and Endocrine Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 4637 JCP, Iowa City, IA 52242, USA. hisakazu-hoshi@uiowa.edu
Abstract:
The quality of surgical treatment is a major determinant of cancer treatment outcomes; however, controlling surgical quality is a difficult task. Surgical treatment of gastric cancers, and especially the benefits of nodal dissection, has been a topic of debate and no consensus has been reached to date. The D2 nodal dissection defined, standardized, and practiced in Japan is a technically challenging procedure but carries better locoregional disease control. This article reviews the current definition of D1, D1 plus, and D2 nodal dissections, as well as the nodal dissection technique, indications for its modification, and the learning curve.
Insights
Surgical quality impacts cancer outcomes. D2 nodal dissection in gastric cancer offers better local control but is technically demanding, requiring specific training and adherence to technique.
Area of Science:
- Surgical Oncology
- Gastrointestinal Cancer Surgery
Background:
- Surgical quality is crucial for cancer treatment success.
- Gastric cancer surgery, particularly lymph node dissection, lacks consensus on optimal techniques.
- The D2 nodal dissection, a Japanese standard, is complex yet improves locoregional control.
Purpose of the Study:
- To review definitions and techniques of D1, D1 plus, and D2 nodal dissections for gastric cancer.
- To discuss indications for modifying nodal dissection and the associated learning curve.
Main Methods:
- Review of current definitions of D1, D1 plus, and D2 nodal dissections.
- Analysis of surgical techniques and indications for modification.
- Evaluation of the learning curve associated with D2 nodal dissection.
Main Results:
- D2 nodal dissection provides superior locoregional disease control in gastric cancer.
- Standardized D2 dissection is technically challenging but achievable.
- Understanding the learning curve is essential for safe implementation.
Conclusions:
- D2 nodal dissection is a key factor in improving gastric cancer surgical outcomes.
- Standardization and training are vital for mastering this complex procedure.
- Further research may refine indications and techniques for optimal patient benefit.
