Extended lymph node dissection in gastric carcinoma: where do we stand after the Dutch and British randomized trials?

摘要: Despite declining incidence in Western Europe and the United States, gastric carcinoma remains second most common cause of cancer death worldwide with over 600,000 deaths per year. The curative treatment primarily surgical. But developments surgery have been slowed West by large percentage patients presenting advanced cancers. In meanwhile, some taken place Japan, which early-stage cancers are more frequently encountered, caused part nationwide mass screening. Depth tumor invasion (T categories), lymph node metastases (N presence distant (M categories) represent three essential prognostic factors for carcinoma, incorporated as key components major stage classifications. Of these, metastasis indicates that patient has a systemic disease precludes possibilities surgical treatment. This does not necessarily apply to metastases, because technique is available whereby regional nodes dissected en bloc primary lesion. resection might lead cure provided were limited within margin dissection. extent dissection long debated Japanese proposed it possible factor improved survival, following initial attempts at anatomically “more thorough” operations McNeer colleagues performed 1950s. Theoretically, removal wider range extended increases chance cure. effect, such be irrelevant even harmful terms increased morbidity mortality if had developed into disease. review concentrates on current controversies offers an optimal management approach view results recent clinical trials.