Faculty Collaboration Database

In Patients with Localized and Resectable Gastric Cancer, What is the Optimal Extent of Lymph Node Dissection-D1 Versus D2 Versus D3? Ann Surg Oncol 2019 Sep;26(9):2912-2932

Date

05/12/2019

Pubmed ID

31076930

DOI

10.1245/s10434-019-07417-5

Scopus ID

2-s2.0-85065721656 (requires institutional sign-in at Scopus site)   28 Citations

Abstract

BACKGROUND: Despite advances in the treatment of patients with gastric cancer, the debate over the optimal extent of lymphadenectomy continues.

METHOD: A review of the classification, rationale for, and boundaries of lymphadenectomy is presented. A review of the available literature comparing D1 versus D2 versus D3 lymphadenectomy was performed and included randomized controlled trials, and prospective and retrospective comparative and non-comparative studies.

RESULTS: Earlier studies demonstrated increased morbidity with D2 compared with D1 lymphadenectomy, with no significant survival benefit. More recent studies have demonstrated survival benefit of a pancreas and spleen-sparing D2 lymphadenectomy in patients with advanced, node-positive tumors. Para-aortic/D3 dissections contribute to increased morbidity, with no survival benefit.

CONCLUSIONS: In patients with resectable gastric adenocarcinoma, a D2 lymph node dissection preserving the pancreas and spleen should be considered standard for optimal staging and treatment, provided it is performed by surgeons with sufficient expertise. Extended lymph node dissections beyond D2 should not be routinely performed as it has been shown to have increased morbidity, with no improvement in outcomes. While systemic chemotherapy should be considered standard in patients undergoing D2 lymphadenectomy, the role of adjuvant radiation continues to evolve.

Author List

Mogal H, Fields R, Maithel SK, Votanopoulos K

MESH terms used to index this publication - Major topics in bold

Follow-Up Studies
Gastrectomy
Humans
Lymph Node Excision
Meta-Analysis as Topic
Organ Sparing Treatments
Pancreatectomy
Prognosis
Prospective Studies
Randomized Controlled Trials as Topic
Retrospective Studies
Splenectomy
Stomach Neoplasms
Survival Rate