Published online Sep 15, 2016. doi: 10.4251/wjgo.v8.i9.707
Peer-review started: April 1, 2016
First decision: May 23, 2016
Revised: June 19, 2016
Accepted: July 11, 2016
Article in press: July 13, 2016
Published online: September 15, 2016
To verify the current status of super-extended lymph node dissection for advanced gastric cancer according to a questionnaire survey.
One-hundred and five institutions responded to the questionnaire. The survey included the following items: Number of experiences, whether performed prophylactically and/or therapeutically, whether preoperative chemotherapy was provided, number of preoperative chemotherapy rounds, and therapeutic options after chemotherapy.
Eighty-seven of the 105 institutions (83%) had performed D3 gastrectomy in the past or continued to perform D3 gastrectomy at present. However, D3 gastrectomy was rarely performed prophylactically in clinical practice. Seventy-eight institutions (74%) indicated that preoperative chemotherapy with curative intent was required for patients suspected of having para-aortic node (PAN) metastases. After chemotherapy, a D3 gastrectomy was scheduled for patients with a complete or partial response, stable disease, and progressive disease at 36 (46%), 28 (36%), and 13 (17%) of the institutions, respectively.
For patients with apparent PAN metastasis, a D3 gastrectomy is typically planned if a few courses of preoperative chemotherapy yield at least a stable disease condition.
Core tip: In this paper, we discussed the current status of super-extended lymph node dissection (LND) for advanced gastric cancer based on the results of a questionnaire survey. A recent study has indicated that prophylactic super-extensive lymphadenectomy does not improve the survival rate in patients with curable gastric cancer. In another study, surgery with para-aortic dissection was effective with the addition of neoadjuvant chemotherapy. Although super-extended LND seems to be rarely accepted worldwide, the rigorous and careful selection of patients can provide long-term survival after systemic LND. Therefore, we present the current status of super-extended LND in Japan.