Extended lymph-node dissection for gastric cancer: a challenge for better survival results

Most Japanese studies have better survival results for gastric cancer after surgery compared to the results reported by Western authors. Japanese surgeons trace their success to early detection and extended lymph-node dissection. Analysis of data from several Japanese and Western surgical departments could not substantiate factors other than the surgical procedure as an explanation for the better survival rates in advanced gastric cancer in Japan. Whether extended lymph-node dissection actually improves survival results or merely rectifies classification which influences stratified survival results, remains to be justified. A prospective randomized study, comparing the Japanese R2 with R1 resection, is initiated in The Netherlands to answer this question. For this purpose we describe the surgical strategy and operative technique of the extended lymph-node procedure.