Gastric cancer with para-aortic lymph nodes metastasis: curable dissection possible but be cautiously selected

This is a reply letter to Dr. M Daniele et al. entitled as "gastric cancer with para-aortic lymph nodes metastasis: do not miss a chance of cure!". Para-aortic lymph node metastasis has been regarded as a pattern of distant metastasis in gastric cancer. Even patients with PAN metastasis undergo extensive lymph nodes, the prognosis is unsatisfactory and the overall survival is not better than the patients receiving palliative chemotherapy. However, for the patients who were responded to the preoperative chemotherapy, subsequent radical gastrectomy performed prolonged survival. Meanwhile, patients who were resistant to the previous chemotherapy were not optimal candidates for curative resection in advanced gastric cancer patients with PAN metastasis. How large with lymph nodes dissection for the patients with initially PAN metastasis after effective neo-chemotherapy is still a controversial issue and needs further large-scale randomized trials.