Is D2 laparoscopic gastrectomy essential for elderly patients with advanced gastric cancer?—reply letter

Abstract

We would like to thank the editorial authors for commenting on "Is D2 laparoscopic gastrectomy essential for elderly patients with advanced gastric cancer? A propensity score matched analysis".This study demonstrated the possible association between D2 laparoscopic gastrectomy (LG) and increased complication rate and no survival benefit of D2 LG in elderly patients (1).Feng et al. commented on perioperative chemotherapy for gastric cancer (GC) patients. Regarding neoadjuvant chemotherapy, we do not have solid evidence which can be applied to Japanese practice. Next, Japanese Gastric Cancer Treatment Guideline recommends adjuvant chemotherapy for patients with advancer GC based on the ACTS-GC study and the CLASSIC study. However, median age was 63 and 56 years in the ACTS-GC study and the CLASSIC study, respectively (2,3). In Japanese real world, adjuvant chemotherapy for elderly patients is performed at surgeon's discretion. Therefore, I believed our cohort represented Japanese practice. As Feng et al. proposed, GC patients without adjuvant chemotherapy may need to be elaborated. However, only a few patients received adjuvant chemotherapy in this study. Our conclusion was not affected, if we excluded the patients who received adjuvant chemotherapy.The optimal extent of lymph node (LN) dissection