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Updated: May 9, 2026

Laparoscopic Radical Gastrectomy for Remnant Gastric Cancer

Laparoscopic Radical Gastrectomy for Remnant Gastric Cancer

Published on: October 31, 2025

Lymph node dissection in resectable advanced gastric cancer.

Wobbe O de Steur¹, Johan L Dikken, Henk H Hartgrink

¹Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. w.o.de_steur @ lumc.nl

Digestive Surgery

|July 23, 2013

Summary

For advanced gastric cancer, subtotal gastrectomy offers lower risks than total gastrectomy. A D2 lymph node dissection, without routine splenectomy, is the standard of care for better patient outcomes.

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Area of Science:

Surgical Oncology
Gastroenterology
Pathology

Background:

Surgical extent for gastric cancer, including gastrectomy and lymphadenectomy, remains a topic of debate.
Historical context traces back to Billroth's first gastrectomy in 1881, with evolving guidelines from the Japanese Research Society for the Study of Gastric Cancer since 1981.

Purpose of the Study:

To review the literature on the extent of gastrectomy and lymphadenectomy for advanced resectable gastric cancer.
To evaluate the optimal surgical approach balancing survival, morbidity, and mortality.

Main Methods:

Literature review of studies on gastrectomy extent and lymphadenectomy (D1 vs. D2) for advanced gastric cancer.
Analysis of outcomes including morbidity, mortality, resection margins, and long-term survival.

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Last Updated: May 9, 2026

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Single Incision Plus One Port Laparoscopic Proximal Gastrectomy with Double Channel Anastomosis for Gastric Cancer Treatment

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Main Results:

Subtotal gastrectomy shows lower morbidity and mortality than total gastrectomy without compromising survival.
D2 lymphadenectomy, when performed by experienced surgeons without routine splenectomy, is associated with better outcomes compared to D1 dissection in Western trials.
Pancreaticosplenectomy increases morbidity and offers no survival benefit unless there is direct tumor invasion.

Conclusions:

A D2 lymphadenectomy without routine splenectomy and pancreatic tail resection is the recommended standard of care for advanced resectable gastric cancer.
Frozen section examination is crucial to prevent positive resection margins.
Centralization of care and auditing can further enhance surgical outcomes.