AB07. Current status of lymphadenectomy for advanced gastric cancer

Abstract: Gastric cancer is one of the most common malignant tumors in the world. The incidence and mortality of gastric cancer is in a high level in China, and most cases are advanced gastric cancers. D2 lymphadenectomy is the standard surgical procedure for advanced gastric cancer and can prevent tumor recurrence, distant metastasis and prolong the survival time of patients. Compared with D1 lymphadenectomy, D2 lymphadenectomy can dissect more lymph nodes and get better radical effect. However, it’s difficult to dissect splenic hilar and splenic artery nodes which are in the deep position and surrounded with a large number of vessels in surgery, the dissection may lead to a large amount of intraoperative bleeding and postoperative complications, even deaths. It’s a challenge for surgeons to dissect particular lymph nodes and make a standard D2 lymphadenectomy safely. There is no lymph node metastasis for a portion of advanced gastric cancer patients and D2 lymphadenectomy is harmful to them. The rate of metastasis to splenic artery and splenic hilum lymph nodes were about 10% according to the recent researches. Patients without lymph nodes metastasis can get benefits from modified lymphadenectomy, however, there are no effectively preoperative or intraoperative tests to predict lymph node metastasis. D1 lymphadenectomy may omit some metastatic lymph nodes and lead to tumor recurrence in advanced gastric cancer. Individual treatment is the main direction of clinical researches in the future. The clinical trials about lymphadenectomy for advanced gastric cancer are introduced to investigate the method, problems and future research direction of lymphadenectomy in this article.

Keywords: Advanced gastric cancer; radical gastrecotomy; lymphadenectomy