The role of lymph node surgery in gastric cancer

Abstract

Abstract In Japan, gastric cancer is the primary cause of death in both males and females. Among early gastric cancers, the elevated lesion is almost always the differentiated type, whereas almost half of the depressed lesions are undifferentiated types. As for advanced gastric cancer, the differentiated type tends to grow expansively as in Borrmann I and II. In contrast, the undifferentiated type is an invasive lesion as in Borrmann III and IV, and preferentially metastasizes to both the peritoneum and regional lymph nodes. Both peritoneal dissemination and lymph node metastasis are more frequently noticed in younger patients than in older patients. The standard operation performed for gastric cancer in Japan is usually gastric resection including complete dissection of group II lymph nodes, which are found along the left gastric and common hepatic arteries, and around the celiac artery. Apart from lymph node metastasis, an important factor influencing the long‐term result of surgery is serosal invasion. In order to improve long‐term results, more aggressive lymph node dissection as well as effective management of the peritoneal invasion should be mandatory. Although there is no therapy superior to that of surgery for gastric cancer, it should be stressed that this malignancy should be treated with an appropriate combination of therapies .