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Lymphadenectomy Considerations Beyond Standard Gastrectomy.

Ahmed Dehal1, Steve Kwon2, Michail N Mavros3

  • 1Department of General Surgery, Southern California Permanente Medical Group, Department of Clinical Sciences, Kaiser Permanente School of Medicine, Los Angeles, Panorama City, CA, USA. ahmed.n.dehal@kp.org.

Annals of Surgical Oncology
|April 3, 2026
PubMed
Summary
This summary is machine-generated.

Lymphadenectomy (LND) is crucial for gastric cancer (GC) surgery, but its role varies in complex cases like conversion surgery and gastroesophageal junction cancers. Individualized approaches are key for optimal patient outcomes.

Keywords:
CancerEmergency gastrectomyGastroesophageal junctionGastrointestinal stromal tumorLymphadenectomyNeuroendocrine tumor

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Area of Science:

  • Surgical Oncology
  • Gastroenterology
  • Cancer Research

Background:

  • Lymphadenectomy (LND) is integral to curative gastrectomy for gastric cancer (GC).
  • Its necessity and extent in non-standard surgical scenarios are less defined.
  • This review examines LND's role in diverse and complex GC contexts.

Purpose of the Study:

  • To review the current evidence and guidelines for lymphadenectomy in various unique gastric cancer scenarios.
  • To highlight areas lacking robust data and emphasize individualized treatment decisions.

Main Methods:

  • Literature review of lymphadenectomy's role in specific gastric cancer contexts.
  • Analysis of existing data for conversion surgery, CRS/HIPEC, GEJ cancers, early GC, emergency gastrectomy, RGC, MSI-H tumors, cancer predisposition syndromes, g-NETs, g-GISTs, and rare gastric tumors.

Main Results:

  • Evidence is limited for LND extent in conversion surgery and CRS/HIPEC for oligometastatic GC; individualized decisions are recommended.
  • Optimal LND for GEJ cancers depends on Siewert classification and invasion depth.
  • Limited LND is common in emergencies, necessitating studies on suboptimal LND impact.
  • Tailored LND is needed for RGC due to unique drainage patterns.
  • LND is vital for staging MSI-H tumors and in specific g-NET cases.
  • LND is generally not required for g-GIST unless specific conditions are met.

Conclusions:

  • Lymphadenectomy's application requires tailored strategies based on tumor characteristics, patient factors, and specific clinical scenarios.
  • Further research is needed to establish optimal LND extent in complex and rare gastric tumor settings.
  • Individualized surgical decision-making remains paramount for optimizing outcomes in gastric cancer management.