Adjuvant Treatment for Gastric Cancer

Abstract

Surgical technique is the most important factor for patients’ long-term outcome. There has been a long debate about the extent of lymph node dissection between Asian surgeons and Western surgeons. Japanese and Korean surgeons believe that wider lymph node dissection, e.g., D2 dissection, is necessary for the better outcome. On the other hand, Western surgeons insisted that there is no evidence for the benefit of D2 dissection over less lymph node dissection, e.g., D1 dissection, based on the negative results of two European studies. MRC ST01 trial compared D1 surgery and D2 surgery in the 1990s and found the 5-year overall survival rate was similar (35%, 33%, respectively). The postoperative morbidity (28% vs 46%) and mortality (6.5% vs 13%) were higher with D2 surgery [1, 2]. Dutch D1D2 study compared the outcomes of D1 surgery with D2 surgery and reported that the 5-year overall survival rate was not different, that is, 34%, 33%, respectively [3]. However, 15-year follow-up data demonstrated the gastric cancer-related death rate was lower in patients with D2 dissection than those with D1 dissection (37% vs 48%) [4]. At present, D2 resection is recommended for advanced gastric cancer, including the USA and Europe [5, 6].