[Standard strategy for lymph node dissection in advanced gastric cancer patients]

The standard strategy for lymph node dissection in advanced gastric cancer patients is defined as D2 lymph node dissection based on the Japanese Classification of Gastric Cancer and Gastric Cancer Treatment Guidelines 2010 edited by the Japanese Gastric Cancer Association. Lymph nodes that should be dissected for D2 are also defined according to whether the surgical method is total gastrectomy or distal gastrectomy. The locations of those lymph nodes are anatomically described in the Japanese Classification of Gastric Cancer: No. 1 to 12. The efficacy of prophylactic extended lymph node dissection in the paraaortic area (No. 16) was not confirmed in a randomized clinical trial (JCOG9501). Splenectomy aiming for complete lymph node dissection at the splenic hilum is under evaluation in a clinical trial (JCOG0110). Optional dissection of the lower mediastinal lymph nodes (No. 110, 111) is recommended for junctional tumors, although the dissection of lymph nodes at the root of the supramesenteric vein (No. 14v) and behind the pancreas (No. 13) remains controversial.