Questionnaire survey regarding the current status of super-extended lymph node dissection in Japan

World J Gastrointest Oncol. 2016 Sep 15;8(9):707-14. doi: 10.4251/wjgo.v8.i9.707.


Aim: To verify the current status of super-extended lymph node dissection for advanced gastric cancer according to a questionnaire survey.

Methods: One-hundred and five institutions responded to the questionnaire. The survey included the following items: Number of experiences, whether performed prophylactically and/or therapeutically, whether preoperative chemotherapy was provided, number of preoperative chemotherapy rounds, and therapeutic options after chemotherapy.

Results: Eighty-seven of the 105 institutions (83%) had performed D3 gastrectomy in the past or continued to perform D3 gastrectomy at present. However, D3 gastrectomy was rarely performed prophylactically in clinical practice. Seventy-eight institutions (74%) indicated that preoperative chemotherapy with curative intent was required for patients suspected of having para-aortic node (PAN) metastases. After chemotherapy, a D3 gastrectomy was scheduled for patients with a complete or partial response, stable disease, and progressive disease at 36 (46%), 28 (36%), and 13 (17%) of the institutions, respectively.

Conclusion: For patients with apparent PAN metastasis, a D3 gastrectomy is typically planned if a few courses of preoperative chemotherapy yield at least a stable disease condition.

Keywords: Advanced gastric cancer; Para-aortic nodal dissection; Preoperative chemotherapy; Questionnaire survey; Radical surgery.