Historical assumptions of lymphadenectomy

Abstract

The role of lymphadenectomy for the treatment of gastric cancer is still very much open to debate. Consequently, Japanese, European and American surgeons perform different typologies of lymphadenectomy because of the absence of randomized clinical trials confirming the superiority of extended lymphadenectomy over less invasive surgery. In Japan, D2 lymphadenectomy has been considered as the gold standard for advanced gastric carcinoma for many years. Although numerous European studies have been conducted in an attempt to find differences between D1 and D2 lymphadenectomy, none has succeeded to date. The decision to wait for results attesting to the fact that D2 guarantees a better outcome than D1 resulted in a long delay in the implementation of D2 as the gold standard treatment in Europe. In the U.S., the study by Macdonald et al.

The effect of learning curve on perioperative outcomes of robotic gastrectomy in two western high‐volume centers

“…This result was also registered in Huang et al's 3 series in which authors reported that 84% of D2 were performed during the learning curve versus 97% after its completion (p = 0.046). In our centers, we have always supported the D2 lymphadenectomy also for early gastric cancer, [22][23][24] except for selected patients as reported in the guidelines. 9 In our series, patients' selection might have been different in the two periods, as in P2 the cohort could represent the ideal candidate for RG and D2 lymphadenectomy.…”