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World J Gastroenterol. Sep 28, 2014; 20(36): 12883-12891
Published online Sep 28, 2014. doi: 10.3748/wjg.v20.i36.12883
Published online Sep 28, 2014. doi: 10.3748/wjg.v20.i36.12883
Problems faced by evidence-based medicine in evaluating lymphadenectomy for gastric cancer
Giuseppe Verlato, Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, 37134 Verona, Italy
Simone Giacopuzzi, Maria Bencivenga, Giovanni De Manzoni, Unit of Upper GI Surgery, University of Verona, 37126 Verona, Italy
Paolo Morgagni, Gastrointestinal and General Surgery Unit, Morgagni-Pierantoni Hospital, 47121 Forlì, Italy
Author contributions: Verlato G, Giacopuzzi S, Bencivenga M, Morgagni P and De Manzoni G solely contributed to this paper.
Correspondence to: Giovanni De Manzoni, MD, Unit of Upper GI Surgery, University of Verona, OCM Borgo Trento, Piazzale Stefani 1, 37126 Verona, Italy. giovanni.demanzoni@univr.it
Telephone: +39-45-8123063 Fax: +39-45-8122484
Received: October 29, 2013
Revised: March 4, 2014
Accepted: April 15, 2014
Published online: September 28, 2014
Revised: March 4, 2014
Accepted: April 15, 2014
Published online: September 28, 2014
Core Tip
Core tip: The extension of lymphadenectomy in advanced gastric cancer has been debated for several decades. Till recently Western surgeons supported limited lymphadenectomy in agreement with a Cochrane review and several meta-analyses, while Japanese surgeons preferred the extended procedure. Nowadays extended lymphadenectomy is considered the procedure of choice by most national guidelines. In gastric cancer surgery evidence-based medicine (EBM) is lagging behind national guidelines, rather than preceding and orienting them. To eliminate this lag, EBM should value to a larger extent Eastern Asian literature and should evaluate not only the quality of the study design but also the quality of surgical procedures.