D2 Lymphadenectomy for Gastric Cancer: Advancements and Technical Considerations

Area of Science:

• Surgical Oncology
• Gastroenterology
• Medical Imaging

Background:

• Lymphadenectomy (LND) is integral to curative gastric cancer (GC) surgery for staging and therapy.
• D2 LND offers survival benefits and acceptable morbidity for locally advanced GC during curative-intent gastrectomy.

Purpose of the Study:

• To review the key aspects of D2 lymphadenectomy for gastric cancer.
• To discuss technical details, controversial elements, and emerging imaging techniques in D2 LND.

Main Methods:

• Literature review of D2 lymphadenectomy in gastric cancer treatment.
• Discussion of anatomical definitions, technical procedures, and controversial surgical aspects.
• Brief review of indocyanine green (ICG) fluorescence imaging applications.

Main Results:

• D2 LND is established as the optimal treatment for locally advanced GC.
• Technical mastery of D2 LND necessitates extensive training and experience.
• ICG imaging shows potential for elucidating GC drainage patterns and enhancing lymph node identification.

Conclusions:

• D2 lymphadenectomy is the standard of care for locally advanced gastric cancer.
• Standardization and centralization of GC treatment, including surgery, are crucial.
• Further research into techniques like ICG imaging may refine surgical approaches.