title: Lymph node dissection in the resection of gastric cancer: review of existing evidence.
abstract: Gastric cancer is one of the leading causes of cancer-related death worldwide. Surgery is the only curative therapy for localized gastric cancer, but the extent of regional lymphadenectomy has been a matter of considerable debate. Extended resections that are regarded as standard procedures in some Asian countries, including Japan and Korea, have not been shown to be as effective in Western countries. The extent of lymphadenectomy for advanced gastric cancer has been studied in many prospective randomized controlled trials. On the other hand, patients with early gastric cancer have an excellent survival rate (>90%) after radical surgery. Lymph node metastasis from early gastric cancer is relatively infrequent. Therefore, it might be practical to perform less invasive surgery for early gastric cancer. In this review article, we examine the evidence for lymph node dissection as radical surgery in advanced gastric cancer and the possibility of limited resection for early gastric cancer.
authors.affiliation: Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tanizawa
authors.forename: Masanori
authors.initials: M
authors.lastname: Terashima
mesh_terms: D000075202:Contraindications; D016629:Esophagectomy; D004947:Esophagus / Q000473:pathology; D005743:Gastrectomy / Q000379:methods*; D005773:Gastroscopy; D006801:Humans; D007564:Japan; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000033:anatomy & histology / Q000473:pathology*; D009361:Neoplasm Invasiveness; D010180:Pancreatectomy; D013156:Splenectomy; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
references.citation: J Gastrointest Surg. 2007 Sep;11(9):1146-53
references.pmid: 17576611
references.citation: Gastric Cancer. 2001;4(1):34-8
references.pmid: 11706625
references.citation: Hepatogastroenterology. 2006 May-Jun;53(69):389-94
references.pmid: 16795979
references.citation: Br J Surg. 2005 Jan;92(1):5-13
references.pmid: 15635680
references.citation: Jpn J Clin Oncol. 2009 Jul;39(7):464-6
references.pmid: 19493869
references.citation: Am Surg. 2004 Jul;70(7):645-8
references.pmid: 15279191
references.citation: Gastric Cancer. 2002;5(1):1-5
references.pmid: 12021853
references.citation: J Clin Oncol. 1998 Apr;16(4):1490-3
references.pmid: 9552056
references.citation: Am J Surg. 2007 Jan;193(1):10-5
references.pmid: 17188080
references.citation: Surg Today. 2001;31(3):196-203
references.pmid: 11318120
references.citation: Cancer. 1995 Sep 15;76(6):935-40
references.pmid: 8625218
references.citation: J Surg Oncol. 2005 Jun 1;90(3):153-65
references.pmid: 15895448
references.citation: Gastric Cancer. 2007;10(1):1-11
references.pmid: 17334711
references.citation: Lancet. 1995 Mar 25;345(8952):745-8
references.pmid: 7891484
references.citation: Surgery. 1998 Feb;123(2):127-30
references.pmid: 9481396
references.citation: World J Surg. 2004 Sep;28(9):857-61
references.pmid: 15593456
references.citation: Br J Surg. 2008 Sep;95(9):1131-5
references.pmid: 18690631
references.citation: Surgery. 2001 Feb;129(2):153-7
references.pmid: 11174707
references.citation: Hepatogastroenterology. 2001 Nov-Dec;48(42):1797-801
references.pmid: 11813627
references.citation: Ann Surg Oncol. 1998 Jun;5(4):338-41
references.pmid: 9641455
references.citation: N Engl J Med. 2002 Nov 21;347(21):1662-9
references.pmid: 12444180
references.citation: Br J Surg. 1996 Nov;83(11):1595-9
references.pmid: 9014684
references.citation: Int J Clin Oncol. 2008 Dec;13(6):483-7
references.pmid: 19093174
references.citation: Cancer. 1989 Nov 15;64(10):2053-62
references.pmid: 2680049
references.citation: N Engl J Med. 2007 Nov 1;357(18):1810-20
references.pmid: 17978289
references.citation: Int J Cancer. 1999 Sep 24;83(1):18-29
references.pmid: 10449602
references.citation: BMJ. 1993 Sep 4;307(6904):591-6
references.pmid: 8401015
references.citation: World J Surg. 1995 May-Jun;19(3):456-60; discussion 461
references.pmid: 7639006
references.citation: Surgery. 1997 Mar;121(3):278-86
references.pmid: 9092128
references.citation: Arch Surg. 2000 Jan;135(1):89-94
references.pmid: 10636354
references.citation: World J Surg. 1997 Jul-Aug;21(6):622-7; discussion 627-8
references.pmid: 9230660
references.citation: Cancer Metastasis Rev. 2006 Jun;25(2):269-77
references.pmid: 16770539
references.citation: Br J Surg. 2003 Jul;90(7):850-3
references.pmid: 12854112
references.citation: Ann Surg Oncol. 1999 Apr-May;6(3):286-9
references.pmid: 10340888
references.citation: Br J Surg. 2001 Mar;88(3):444-9
references.pmid: 11260114
references.citation: Lancet Oncol. 2006 Aug;7(8):644-51
references.pmid: 16887481
references.citation: Hepatogastroenterology. 1999 Jan-Feb;46(25):549-54
references.pmid: 10228860
references.citation: Br J Surg. 1988 Feb;75(2):110-2
references.pmid: 3349293
references.citation: Int Surg. 1995 Jul-Sep;80(3):200-3
references.pmid: 8775601
references.citation: Hepatogastroenterology. 2000 Mar-Apr;47(32):586-9
references.pmid: 10791244
references.citation: J Clin Oncol. 1994 Feb;12(2):417-22
references.pmid: 8113850
references.citation: Hepatogastroenterology. 2006 Mar-Apr;53(68):301-3
references.pmid: 16608044
references.citation: Lancet. 1996 Apr 13;347(9007):995-9
references.pmid: 8606613
references.citation: Gut. 2001 Feb;48(2):225-9
references.pmid: 11156645
references.citation: Ann Surg Oncol. 2000 Oct;7(9):669-73
references.pmid: 11034244
references.citation: Int J Clin Oncol. 2008 Apr;13(2):132-7
references.pmid: 18463957
references.citation: Gastric Cancer. 2007;10(3):167-72
references.pmid: 17922094
references.citation: Surgery. 2002 Apr;131(4):401-7
references.pmid: 11935130
references.citation: J Clin Oncol. 2004 Jul 15;22(14):2767-73
references.pmid: 15199090
references.citation: Scand J Surg. 2006;95(4):256-9
references.pmid: 17249274
references.citation: N Engl J Med. 1999 Mar 25;340(12):908-14
references.pmid: 10089184
references.citation: Br J Surg. 1992 Mar;79(3):245-7
references.pmid: 1555092
references.citation: N Engl J Med. 2008 Jul 31;359(5):453-62
references.pmid: 18669424
references.citation: Br J Surg. 1999 Jan;86(1):119-22
references.pmid: 10027374
references.citation: Ann Surg. 2007 Dec;246(6):992-1000; discussion 1000-1
references.pmid: 18043101
references.citation: N Engl J Med. 2001 Sep 6;345(10):725-30
references.pmid: 11547741
references.citation: World J Surg. 1995 Jul-Aug;19(4):532-6
references.pmid: 7676695
references.citation: World J Surg. 1997 Oct;21(8):845-8; discussion 849
references.pmid: 9327676
references.citation: Scand J Surg. 2006;95(4):232-5
references.pmid: 17249270
references.citation: J Am Coll Surg. 2009 Sep;209(3):297-301
references.pmid: 19717032
references.citation: Int J Radiat Oncol Biol Phys. 1982 Jan;8(1):1-11
references.pmid: 7061243
references.citation: Cancer. 1993 Dec 1;72(11):3174-8
references.pmid: 8242540
references.citation: Cancer. 1948 Sep;1(3):427-30
references.pmid: 18887909
references.citation: N Engl J Med. 2006 Jul 6;355(1):11-20
references.pmid: 16822992
references.citation: Surg Today. 2005;35(6):425-31
references.pmid: 15912287
references.citation: Eur J Surg Oncol. 2004 Apr;30(3):303-8
references.pmid: 15028313
references.citation: Int Surg. 1997 Apr-Jun;82(2):150-4
references.pmid: 9331843
references.citation: Gastric Cancer. 2000 Dec;3(4):219-225
references.pmid: 11984739
references.citation: J Clin Oncol. 2004 Jun 1;22(11):2069-77
references.pmid: 15082726
references.citation: World J Surg. 1991 Sep-Oct;15(5):628-33; discussion 633-4
references.pmid: 1949863
references.citation: Br J Surg. 2006 May;93(5):559-63
references.pmid: 16607678
references.citation: Surgery. 1998 Feb;123(2):165-70
references.pmid: 9481402
references.citation: Ann Surg Oncol. 2006 Sep;13(9):1175-81
references.pmid: 16947008
references.citation: Gastric Cancer. 2002;5(3):177-82
references.pmid: 12378346
references.citation: Jpn J Clin Oncol. 2002 Sep;32(9):363-4
references.pmid: 12417603
references.citation: Gut. 1992 Oct;33(10):1318-22
references.pmid: 1446852
references.citation: Hepatogastroenterology. 2000 May-Jun;47(33):893-6
references.pmid: 10919056
references.citation: Lancet Oncol. 2006 Apr;7(4):309-15
references.pmid: 16574546
references.citation: J Surg Oncol. 2009 Jun 1;99(7):395-401
references.pmid: 19347884
references.citation: Jpn J Surg. 1981 Mar;11(2):127-39
references.pmid: 7300058
references.citation: Ann Surg. 1994 Aug;220(2):176-82
references.pmid: 8053740
references.citation: Br J Surg. 2004 Mar;91(3):283-7
references.pmid: 14991627
references.citation: Br J Surg. 1996 Feb;83(2):266-9
references.pmid: 8689185
references.citation: Int J Clin Oncol. 2006 Oct;11(5):357-66
references.pmid: 17058133
references.citation: Gastric Cancer. 1998 Dec;1(1):10-24
references.pmid: 11957040
references.citation: Br J Surg. 1998 Jun;85(6):835-9
references.pmid: 9667719
references.citation: Br J Cancer. 1999 Mar;79(9-10):1522-30
references.pmid: 10188901
references.citation: Ann Surg Oncol. 2009 May;16(5):1304-9
references.pmid: 19241107
references.citation: Am J Surg. 1995 Sep;170(3):285-8
references.pmid: 7661298