Treatment strategies in node-negative gastric cancer

Lymph node metastasis is the most important prognostic factor in gastric cancer (1-3). Curative resection including adequate lymphadenectomy provided the chance of a cure for localized disease. However, node-negative gastric cancer patients undergoing extensive lymphadenectomy also experience recurrence and distant metastases (4,5). In the issue of Journal of Gastrointestinal Surgery, Liu and colleagues (6) show that the invasion in lymphatic or vascular vessels, and depth of tumor invasion were independent prognostic factors in node-negative gastric cancer and therefore suggest considering the use of adjuvant therapies in patients with high risk for recurrence. However, it should be argued that only 234 (5.3%) gastric cancer patients undergoing curative D2 gastrectomy were free of lymph node metastasis and 67 T1 tumors (28.6%) and none of T4 tumor reported in their study.