Lymphadenectomy in Proximal Gastric Cancer—Location, Location, Location

Ye et al discusses lymphadenectomy in proximal gastric cancer. The extent of lymphadenectomy in operative management of gastric cancer has been subject to long-standing debate, stemming from variations in epidemiology, experiences, and outcomes between centers of the Eastern and Western hemispheres. For example, gastric cancer incidence in the US is only one-tenth that of South Korea, gastrectomies are not consistently aggregated to high-volume centers, and extent of lymphadenectomy is not standardized among surgeons. Historically, D2 lymphadenectomy was not widely adopted in the US due to European trials in the 1990s suggesting increased short-term morbidity and mortality. However, 15-year follow-up studies have since shown lower rates of locoregional recurrence and cancer-related deaths (37% vs 48%) in patients who underwent D2 dissection over D1, and short-term morbidity was more strongly attributable to concomitant splenectomy and pancreatectomy.