Lymph node dissection for gastric cancer

Complete tumor removal with margins of clearance at the resection lines mus t be the aim of today's surgical treatment of gastric cancer, and this must be applied even in lymph node dissection. But, over the last few decades, the extent and impact of lymphadenectomy remains controversial. Whereas Jap anese centers advocate extensive lymph node dissection as the base of their excellent results, many Western surgeons, supported by actual randomized t rials, believe that the potential benefit of such procedures cannot outweig h the risk of increased postoperative morbidity and mortality. However, if lymphadenectomy is restricted to the removal of nodes only, it does not inf luence the operative risk. Further, the lymph node ratio and number of lymp h nodes involved are relevant prognostic parameters. Survival improvement c an be achieved in a moderate degree of metastatic involvement of the nodes (pN0,1). Therefore, systematic lymph node dissection should be an integral part of the curative resection sought. Limited or no lymphadenectomy might be indicated in noncurative surgery or in special types of mucosal early ga stric cancer, respectively. (C) 1999 Wiley-Liss, Inc.