Abstract
D2 procedure has been accepted in Far East as the
standard treatment for both early (EGC) and advanced
gastric cancer (AGC) for many decades. Recently
EGC has been successfully treated with endoscopy
by endoscopic mucosal resection or endoscopic
submucosal dissection, when restricted or extended
Gotoda's criteria can be applied and D1+ surgery is
offered only to patients not fitted for less invasive
treatment. Furthermore, two randomised controlled
trials (RCTs) have been demonstrating the non inferiority
of minimally invasive technique as compared to
standard open surgery for the treatment of early cases
and recently the feasibility of adequate D1+ dissection
has been demonstrated also for the robot assisted
technique. In case of AGC the debate on the extent
of nodal dissection has been open for many decades.
While D2 gastrectomy was performed as the standard
procedure in eastern countries, mostly based on
observational and retrospective studies, in the west theMedical Research Council (MRC), Dutch and Italian RCTs
have been conducted to show a survival benefit of D2
over D1 with evidence based medicine. Unfortunately
both the MRC and the Dutch trials failed to show a
survival benefit after the D2 procedure, mostly due to
the significant increase of postoperative morbidity and
mortality, which was referred to splenopancreatectomy.
Only 15 years after the conclusion of its accrual, the
Dutch trial could report a significant decrease of recurrence
after D2 procedure. Recently the long term
survival analysis of the Italian RCT could demonstrate
a benefit for patients with positive nodes treated with
D2 gastrectomy without splenopancreatectomy. As
nowadays also in western countries D2 procedure can
be done safely with pancreas preserving technique and
without preventive splenectomy, it has been suggested
in several national guidelines as the recommended
procedure for patients with AGC.
Lingua originale | Inglese |
---|---|
pagine (da-a) | 2875-2893 |
Numero di pagine | 19 |
Rivista | World Journal of Gastroenterology |
Volume | 22 |
DOI | |
Stato di pubblicazione | Pubblicato - 2016 |
Keywords
- D1 gastrectomy
- D1 plus gastrectomy
- D2 gastrectomy
- Gastric cancer
- Laparoscopic lymphadenectomy
- Lymph node dissection
- Lymphadenectomy
- Robot assisted lymphadenectomy