[Precision lymphadenectomy for locally advanced gastric cancer]

Based upon studies from randomized clinical trials, the extended (D2) lymph node dissection is now recommended as a standard procedure for local advanced gastric cancer worldwide. However, the rational extent lymphadenectomy for local advanced gastric cancer has remained a topic of debate in the past decades. Patients with more lymph nodes harvested may have better survival. Negative node count may provide prognostic information for gastric cancer patients. The extranodal metastasis is significantly associated with the survival of gastric cancer patients and should be incorporated into N stage. In total gastrectomy for proximal gastric cancer without great curvature invasion, prophylactic splenectomy should be avoided not only for operative safety but also for survival benefit. The metastatic rate of No14v nodes for patients with distal stage III( disease is about 20%, so D2+ No.14v lymphadenectomy may be an option in a potentially curative gastrectomy for tumors with metastasis to the No.6 nodes. According to JCOG9501, extend D2+PAND should not be used to treat curable stage T2b, T3, N1-2 (II(B-III(A) gastric cancer. But the clinical benefit of D2+PAND for patients with stage T4 and/or stage N3 (III(B, III(C) disease could not be determined. The quality control of D2 procedure is very important for the prognosis of gastric cancer patients. Base on the experience from Europe, Unite States and China, centralization of gastric cancer treatment will improve the outcome of gastric cancer operation effectively.