Distant nodal metastasis: is it always an unresectable disease?

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Gastric cancer with distant nodal metastases is typically classified as metastatic disease.
• Current treatment strategies often focus on systemic therapies.

Purpose of the Study:

• To analyze the existing literature on the surgical treatment of gastric cancer patients with distant nodal metastases.
• To evaluate the role and outcomes of extended surgery in specific nodal basins.

Main Methods:

• A systematic literature search was conducted across major databases (Medline, Embase, Cochrane, Web-of-Science).
• Included studies comprised clinical series and literature reviews, with a focus on English-language publications.
• Analysis specifically considered papers addressing surgery for nodal basins beyond the standard D2 dissection area.

Main Results:

• Only 11 papers were identified that discussed surgery for nodal basins outside the D2 dissection area.
• In selected cases, extended surgery, as part of a comprehensive treatment pathway including chemotherapy, demonstrated potential for prolonging survival.

Conclusions:

• For gastric cancer patients with nodal metastases outside the loco-regional area, surgery can be considered for metastatic nodes in stations 13 and 16.
• Extended surgery may be beneficial in carefully selected patients when integrated with systemic chemotherapy.