title: Lymphadenectomy for gastric cancer: still a matter of debate?
abstract: BACKGROUND
  For more than a century the extent of surgical treatment of gastric cancer is a matter of debate. Through experience, evaluation and research, the outcome of gastric cancer has improved. Many aspects are of influence of outcome, but only a radical resection can offer long-term outcomes. In this review, we will discuss the history and current status of the extent of lymph node dissection.
  
  
  METHODS
  Some issues about the extent of gastric resection seem to have been settled. For survival it is not necessary to perform a total gastrectomy if free resection margins can be obtained with a subtotal gastrectomy. In the context of postoperative morbidity and mortality a subtotal gastrectomy is to be preferred. Microscopic resection line involvement has shown to be of great influence on prognosis.
  
  
  CONCLUSIONS
  At this moment the main discussion centres around the extent of lymph node dissection, locoregional recurrence and to the influence of additional treatment. For many years it has been debated whether an extended lymph node dissection for gastric cancer is beneficial. Theoretically, removal of a wider range of lymph nodes by extended lymph node dissection increases the chances for cure. Such resection, however, may be irrelevant if there are no lymph nodes affected or if the cancer has developed into a systemic disease, or if it increases morbidity and mortality substantially.
  
  
  CONCLUSIONS
  Relapse after curative surgery because of local recurrence or regional lymph node metastasis have been shown in up to 87.5% of patients. The extent of surgery, however, may be of influence on the locoregional recurrence rate.
authors.affiliation: Department of Digestive Surgery, Catholic University, A. Gemelli Hospital, Rome, Italy.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Doglietto
authors.forename: Fausto
authors.initials: F
authors.lastname: Rosa
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bossola
authors.forename: Fabio
authors.initials: F
authors.lastname: Pacelli
mesh_terms: D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D016032:Randomized Controlled Trials as Topic; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*