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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Feb 15, 2016; 8(2): 136-146
Published online Feb 15, 2016. doi: 10.4251/wjgo.v8.i2.136
Clinical significance of lymphadenectomy in patients with gastric cancer
Dezső Tóth, János Plósz, Miklós Török
Dezső Tóth, Department of General Surgery, Kenézy Teaching Hospital, 4043 Debrecen, Hungary
János Plósz, Department of Internal Medicine, Kenézy Teaching Hospital, 4043 Debrecen, Hungary
Miklós Török, Department of Pathology, Kenézy Teaching Hospital, 4043 Debrecen, Hungary
Author contributions: Tóth D, Plósz J and Török M designed this review; Tóth D wrote and edited the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dezső Tóth, MD, PhD, Associate Professor, Department of General Surgery, Kenézy Teaching Hospital, 2-26 Bartók Street, 4043 Debrecen, Hungary. detoth@gmail.com
Telephone: +36-30-9388867 Fax: +36-52-511797
Received: April 24, 2015
Peer-review started: April 26, 2015
First decision: August 1, 2015
Revised: November 18, 2015
Accepted: December 17, 2015
Article in press: December 18, 2015
Published online: February 15, 2016
Abstract

Approximately thirty percent of patients with gastric cancer undergo an avoidable lymph node dissection with a higher rate of postoperative complication. Comparing the D1 and D2 dissections, it was found that there is a significant difference in morbidity, favoured D1 dissection without any difference in overall survival. Subgroup analysis of patients with T3 tumor shows a survival difference favoring D2 lymphadenectomy, and there is a better gastric cancer-related death and non-statistically significant improvement of survival for node-positive disease in patients with D2 dissection. However, the extended lymphadenectomy could improve stage-specific survival owing to the stage migration phenomenon. The deployment of centralization and application of national guidelines could improve the surgical outcomes. The Japanese and European guidelines enclose the D2 lymphadenectomy as the gold standard in R0 resection. In the individualized, stage-adapted gastric cancer surgery the Maruyama computer program (MCP) can estimate lymph node involvement preoperatively with high accuracy and in addition the Maruyama Index less than 5 has a better impact on survival, than D-level guided surgery. For these reasons, the preoperative application of MCP is recommended routinely, with an aim to perform “low Maruyama Index surgery”. The sentinel lymph node biopsy (SNB) may decrease the number of redundant lymphadenectomy intraoperatively with a high detection rate (93.7%) and an accuracy of 92%. More accurate stage-adapted surgery could be performed using the MCP and SNB in parallel fashion in gastric cancer.

Keywords: Gastric cancer, Surgery, Lymphadenectomy, Sentinel node biopsy, Maruyama computer program

Core tip: Comparing the D1 and D2 dissections, it was found that there is a significant difference in postoperative morbidity and mortality, favoured D1 dissection without any difference in overall survival. The implementation of centralization and application of national guidelines could improve the surgical outcomes. More accurate stage-adapted surgery could be performed using the Maruyama computer program and sentinel lymph node biopsy in parallel fashion in gastric cancer.