Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Sep 15, 2016; 8(9): 707-714
Published online Sep 15, 2016. doi: 10.4251/wjgo.v8.i9.707
Questionnaire survey regarding the current status of super-extended lymph node dissection in Japan
Shinji Morita, Takeo Fukagawa, Hisataka Fujiwara, Hitoshi Katai
Shinji Morita, Takeo Fukagawa, Hisataka Fujiwara, Hitoshi Katai, Department of Surgical Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan
Author contributions: Morita S designed and performed the research and wrote the paper; Fukagawa T and Katai H supervised the report; Fujiwara H provided clinical advice; Katai H designed the research and contributed to the analysis.
Institutional review board statement: We have not included a statement of IRB review, since IRB approval is not required for questionnaire research that does not provide personal information.
Informed consent statement: Patients were not required to give informed consent prior to participation in the study because the analysis used anonymous clinical data that were obtained after each patient had agreed to receive treatment and had provided written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
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:
Correspondence to: Shinji Morita, MD, Department of Surgical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
Telephone: +81-3-35422511 Fax: +81-3-25422545
Received: March 28, 2016
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.

Keywords: Questionnaire survey, Advanced gastric cancer, Radical surgery, Para-aortic nodal dissection, Preoperative chemotherapy

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.