Optimal lymph node dissection for gastric cancer: a narrative review.

Area of Science:

• Surgical Oncology
• Gastroenterology
• Cancer Research

Background:

• Gastric cancer management debates center on lymph node (LN) dissection extent.
• LN invasion is the primary prognostic factor in gastric cancer.
• Historical LN station classifications (1-16) and dissection types (D1, D2, D3) lack universal adoption.

Purpose of the Study:

• To advocate for extended lymph node dissection in gastric cancer surgery.
• To comprehensively review current lymphadenectomy definitions and classifications.
• To analyze randomized controlled trials on LN dissection outcomes.

Main Methods:

• Literature review of existing studies on gastric cancer lymphadenectomy.
• Analysis of randomized controlled trials evaluating morbidity, mortality, and survival.
• Examination of international guidelines and recommendations.

Main Results:

• Optimal extent of lymph node dissection remains debated.
• Extensive dissections historically showed high morbidity without clear survival gains.
• Review synthesizes evidence to support extended lymphadenectomy.

Conclusions:

• Extended lymph node dissection may improve outcomes in gastric cancer.
• Standardizing LN dissection definitions is essential for comparable research.
• Evidence supports refining surgical guidelines for gastric cancer.