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Gastrointestinal Cancer

Lymphadenectomy for Gastric Adenocarcinoma: Should West Meet East?

^aDepartment of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; ^bDepartment of Surgery, Seoul National University Hospital, Seoul University College of Medicine, Seoul, South Korea

Key Words. Gastric cancer • Surgery • Lymphadenectomy • Outcomes • Review

Correspondence: Sam S. Yoon, M.D., Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Yawkey 7B-7926, 55 Fruit Street, Boston, MA 02114, USA. Telephone: 617-726-4241; Fax: 617-724-895; e-mail: syoon{at}partners.org

Received April 6, 2009; accepted for publication August 6, 2009; first published online in THE ONCOLOGIST Express on September 8, 2009.

Disclosures: Sam S. Yoon: None; Han-Kwang Yang: None.

Section editors Richard M. Goldberg, Patrick G. Johnston, and Peter J. O'Dwyer have disclosed no financial relationships relevant to the content of this article.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias.

The extent of lymphadenectomy that should be performed for gastric adenocarcinoma has been a topic of persistent debate. In countries such as Japan and Korea, where the incidence of gastric adenocarcinoma is high, more extensive (e.g., D2) lymphadenectomies are routinely performed, usually by experienced surgeons with low morbidity and mortality. In western countries such as the U.S., where the incidence of gastric adenocarcinoma is tenfold lower, the performance of more extensive lymphadenectomies is generally limited to specialized centers, and quite possibly the majority of patients are treated at nonreferral centers with less than a D1 lymphadenectomy. There is little disagreement among gastric cancer experts that the minimum lymphadenectomy that should be performed for gastric adenocarcinoma should be at least a D1 lymphadenectomy. Two large, prospective randomized trials performed in the United Kingdom and the Netherlands failed to demonstrate a survival benefit of D2 over D1 lymphadenectomy, but these trials have been criticized for high surgical morbidity and mortality rates in the D2 group. More recent studies have demonstrated that western surgeons can be trained to perform D2 lymphadenectomies on western patients with low morbidity and mortality. Retrospective analyses and one prospective, randomized trial suggest that there may be some benefits to more extensive lymphadenectomies when performed safely, but this assertion requires further validation. This article provides an update on the current literature regarding the extent of lymphadenectomy for gastric adenocarcinoma.