Is D2 lymph node dissection necessary for early gastric cancer?

Abstract

D2 lymphadenectomy in patients with early GC had little survival benefit because (1) metastasis to level 2 nodes was rare, (2) most causes of death were not related to the tumor, and (3) more than half the recurrences were hematogenous. Use of radical lymphadenectomy for early GC should be limited.

Trends in characteristics of surgically treated early gastric cancer patients after the introduction of gastric cancer treatment guidelines in Japan

“…As a result, the proportion of patients undergoing gastrectomy with D2 or greater extended lymphadenectomy was signifi cantly smaller in our Guidelines group (29.7%) than in the control group (62.5%). Nevertheless the 5-year survival rate in the Guidelines group (94.2%) was similar to that in the control group (92.3%) and was also similar to that for patients undergoing gastrectomy with D2 lymphadenectomy in previous reports [18,19].…”

Recurrence in early gastric cancer with lymph node metastasis

“…However, recent reports have raised questions about performing routine D2 lymphadenectomy for EGC. Yoshikawa et al [10] reported that involvement of the second tier of lymph nodes (pN2 according to the Japanese classifi cation) was rare, and that D2 lymphadenectomy for EGC should be limited because of its doubtful impact on survival. In the present series, 2.7% of all patients with EGC (n = 2368) had pN2 metastasis, and this is consistent with rates of 2%-2.5% reported by other authors [10,11].…”

“…Yoshikawa et al [10] reported that involvement of the second tier of lymph nodes (pN2 according to the Japanese classifi cation) was rare, and that D2 lymphadenectomy for EGC should be limited because of its doubtful impact on survival. In the present series, 2.7% of all patients with EGC (n = 2368) had pN2 metastasis, and this is consistent with rates of 2%-2.5% reported by other authors [10,11]. Although D2 lymphadenectomy has been carried out safely with low mortality (0.8% [12] at Japanese high-volume centers), Western studies have shown higher morbidity and mortality rates after this procedure [13,14].…”

Two rare cases of node-positive differentiated gastric cancer despite their infiltration to sm1, their small size, and lack of lymphatic invasion into the submucosal layer

“…On the other hand, several reports have demonstrated the safety from lymphatic metastasis in a limited subgroup of sm1 gastric cancers [6][7][8][9][10][11]. This has raised the question of whether distal or total gastrectomy with lymph node dissection [12][13][14] is necessary for small, differentiated gastric cancers with a depth of sm1.…”