Lymphadenectomy in Proximal Gastric Cancer—Location, Location, Location
Mené sur 526 patients atteints d'un cancer gastrique proximal avancé sans envahissement de la grande courbure (âge moyen : 60,6 ans ; 74,5 % d'hommes), cet essai randomisé évalue l'efficacité, du point de vue de la survie sans maladie à 3 ans, d'une gastrectomie laparoscopique totale associée à une lymphadénectomie hilaire splénique préservant la rate
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. D2 lymphadenectomies are now increasingly performed with the 8th edition American Joint Committee on Cancer staging guidelines recommending ideally 30 nodes for pathologic staging but 16 nodes at a minimum, more similarly reflecting the Japanese Gastric Cancer Association 5th edition guidelines.
JAMA Surgery , éditorial, 2021