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

Abstract

We read with great interest the recent published study written by Sakaguchi and colleagues entitled "Is D2 laparoscopic gastrectomy essential for elderly patients with advanced gastric cancer? A propensity score matched analysis" (1), published in Journal of Gastrointestinal Oncology. The standard D2 gastrectomy has increasingly been adopted for elderly patients with gastric cancer (GC). However, the necessity of the standard D2 gastrectomy remains controversial, especially in older patients with advanced GC. With a total of 119 patients that underwent laparoscopic surgery with or without standard D2 gastrectomy. The authors have shown that D2 laparoscopic gastrectomy (D2 LG) is not recommended as a routine operation for elderly patients with GC. Although some limitations discussed by the authors, there still are some defects we are concerned.To begin with, regarding inclusion criteria, the eligible patients were diagnosed with clinical T1N+ or clinical T2-4 and age ≥75 years. Nevertheless, for patients with clinically staged T1N+ or T2-T4a, the standard treatment is gastrectomy with adequate lymphadenectomy and perform perioperative chemotherapy routinely to provide a lower recurrence rate and longer survival (2). In this study, only 7 patients and 5 patients received adjuvant chemotherapy in the D2 LG and non-D2 LG groups, respectively. Thus, no adjuvant chemotherapy GC patients need to be elaborated. What's more, to avoid the impact of advanced age on survival, we recommend lowering the age to 70 years.Second, after careful reading, we found that there is an obvious typographic error in Tab. 3. Tab.

The “quadrant-sandwich” method in clockwise modular D2 lymph node dissection in laparoscopic total gastrectomy: a retrospective cohort study

“…The safety and efficacy of traditional laparoscopic surgery have been confirmed ( 9 - 11 ), but traditional laparoscopic radical gastrectomy has to first fully free the greater omentum and then deal with the splenic gastric ligament, followed by the duodenum, hepaticoduodenal ligament, left gastric vessels, and esophagus ( 12 , 13 ). Insufficient dissection of the mesenteric fat tissue on both sides of the blood vessels when operating in each area results in insufficient exposure of the blood vessels.…”