Excerpt
Gastric cancer is the second most common cause of cancer-related death worldwide. Although there are regional differences, the prognosis after curative intent surgery remains low in Europe and North America, with 5-year survival after surgery ranging between 25 and 35 % [
1]. In East Asia, post-surgical 5-year survival has been reported to be >60 % [
2,
3]. The possible reasons for this are myriad and a source of much debate; they include a high rate of early disease due to screening, different histologic profile, and more extensive surgical resection, the latter of which is directly pertinent to the present article. Given the poor overall survival after curative intent surgery for gastric cancer in the West, there has been a concerted effort to identify possible targets to improve this oncologic outcome. Indeed, advances in adjuvant and perioperative therapies, incorporating either chemoradiotherapy [
4] or chemotherapy alone [
3,
5,
6], have greatly improved survival in patients with gastric cancer. Despite these initiatives, a significant proportion of patients still recur either locally or regionally, begging the question of whether greater local therapy in the form of extended lymphadenectomy is not only warranted but necessary. For the purposes of this article, limited lymphadenectomy is defined as a D1 dissection as described by the Japanese Research Society for the Study of Gastric Cancer [
7], and extended lymphadenectomy is considered anything more extensive than this (D2, D2 + para-aortic lymph nodes, or D3). In attempting to convince the reader that extended lymphadenectomy is indeed the best therapy for locally advanced gastric cancer, I begin by highlighting the rationale for this approach and follow with a detailed analysis of the available literature on the topic. …
