LYMPHADENECTOMY FOR GASTRIC-CANCER IN CLINICAL-TRIALS - UPDATE

The controversy over the value of extended lymph node dissection for t reatment of gastric cancer is fiercely debated. Whereas Japanese surge ons claim that the superior survival rates in their series are due to extensive resection (D2 resection), many Western authorities believe t hat their results only reflect differences in the prevalence of progno stic factors, inconsistencies between Japanese and Western staging sys tems, and the phenomenon of ''stage migration,'' which occurs with ext ensive resection, Two small randomized prospective trials from Dong Ko ng and Cape Town showed a tendency toward high morbidity with extensiv e lymph node dissection but no survival benefit. In contrast, the rece ntly completed prospective German Gastric Carcinoma Study demonstrated a clear survival advantage with D2 resection for tumor stages II and IIIa with no increase in perioperative morbidity or mortality. The lon g-term results of the still ongoing randomized MRC and Dutch trials ar e therefore eagerly awaited.