Current status of extended ‘D2 plus’ lymphadenectomy in advanced gastric cancer (Review)

Abstract

The extent of lymph node (LN) dissection has been a topic of interest in gastric cancer (GC) surgery. D2 lymphadenectomy is considered the standard surgical procedure for most resectable advanced GC cases. The value and indications of more extended lymphadenectomy than D2 remain unclear. Currently, the controversial stations beyond the D2 range are mainly focused on no. 14v, no. 16a2/b1 and no. 13 LN stations. The metastatic rate of no. 14v LN is relatively high in advanced distal GC, particularly in patients with suspicious no. 6 LN metastasis. D2 plus no. 14v LN dissection may be attributed to improved survival outcomes for patients with obvious no. 6 LN metastasis. Although GC with para-aortic lymph node (PALN) metastases is considered an M1 disease beyond surgical cure, patients with limited PALN metastases may benefit from the treatment strategy of adjuvant chemotherapy followed by D2 plus no. 16a2-b1 LN dissection. In addition, D2 plus no. 13 LN dissection may be an option in a potentially curative gastrectomy for GC with duodenal invasion. The present review discusses the current status and future perspectives of D2 plus lymphadenectomy.

Minimally Invasive and Open Gastrectomy for Gastric Cancer: A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials

“… 84 Another example is lymphadenectomy, where the removal of the D2 nodes is considered the standard surgical procedure for the majority of patients with resectable gastric carcinoma. 85 Controversary remains in relation to resection beyond D2 for cases of advanced disease, for several reasons, including the reduced operative freedom, the significant difficulty controlling haemorrhage, and the relative ease of trauma to local structures. 86 The results of the present NMA show a significant reduction in LNY following LAG, with similar outcomes observed following OG and RG, indicating that RG may offer an advantage over LAG for technically difficult manoeuvres such as extensive lymphatic resection during ‘D2 plus’ lymphadenectomy for advanced gastric cancer.…”

“… 86 The results of the present NMA show a significant reduction in LNY following LAG, with similar outcomes observed following OG and RG, indicating that RG may offer an advantage over LAG for technically difficult manoeuvres such as extensive lymphatic resection during ‘D2 plus’ lymphadenectomy for advanced gastric cancer. 85 …”