A prospective pilot study of extended (D3) and superextended para-aortic lymphadenectomy (D4) in patients with T3 or T4 gastric cancer managed by total gastrectomy

Abstract

Surgical treatment of microscopic disease in grossly normal para-aortic lymph nodes may generate occasional long-term survivors. Selecting appropriate candidates who might benefit from D4 resections needs to be refined. On the basis of this study, a nationwide study should be considered.

Total Gastrectomy Is Not Always Necessary for Advanced Gastric Cancer of the Cardia

“…The reason for the popular use of TG seems to be due to its lower mortality and morbidity, as well as the ease of reconstruction, avoiding the postoperative esophageal reflux as compared to PG [12]. However, the most emphasized point is that it is possible to obtain a sufficient surgical margin, including resection of the involved neighboring organs, and to perform extended LN dissection [8, 12, 13]. Most Japanese surgeons believe that more extended surgery including prophylactic LN dissection achieves a better prognosis.…”

“…On the contrary, even more extensive surgery, the so-called D 4 -operation with para-aortic LN (No. 16) dissection, has been enthusiastically performed and studied in many Japanese institutions [8]. …”

“…TG was performed in 145 patients, including noncurative and palliative procedures. Curative TG, with at least D 2 dissection [8], was performed in 55 patients for tumors mainly in the uper third of the stomach, and these patients were examined in this study. Patients with multiple cancers in the stomach or special lesions such as squamous cell carcinoma, or carcinoma arising from the esophagus were excluded.…”

“…Moreover, whether TG achieves more curability than partial resection such as proximal gastrectomy (PG) with respect to long-term survival is disputed [3, 4, 5]. Proponents of TG suggest that complete resection achieves a tumor-free margin and allows more extended lymphadenectomy [2, 7, 8]. Most surgeons in Japan believe that TG is the most curative operation and that it achieves a better prognosis.…”

D3- versus D2-Dissektion beim Magenkarzinom Eine Fall-Kontroll-Studie hinsichtlich postoperativer Morbidität, Letalität und onkologischen Frühergebnissen

“…In Japan wird derzeit sogar zunehmend noch über das Kompartiment D3 hinausgehend disseziert. So wurde bei fortgeschrittenen Tumoren bereits über eine Entfernung der paraaortalen und interaortokavalen Lymphknoten bis hin zur Iliakalbifurkation berichtet [25]. Folglich prüft derzeit eine multizentrische prospektiv randomisierte Studie den Wert einer ausgedehnten paraaortalen Dissektion bei Patienten mit paraaortalen Lymphknotenmetastasen [27].…”