Gastric Cancer: A Multidisciplinary Approach

The correct answer is the 3rd option. Based on a National Cancer Data Base report of 50,169 gastric carcinoma cases diagnosed during the years 1985-1996 and treated with gastrectomy, 5-year stage-stratified survival increased for cases with ≥15 lymph nodes analyzed (Hundahl S. et al., Cancer 2000). Lymph node dissection may be classified as D0, D1 or D2 depending on the regions of lymph nodes resected. D0 would involve no further nodal dissection beyond gastrectomy. D1 resection includes the following: right/left cardia, lesser/greater curvature, and suprapyloric/infrapyloric regions. D2 involves resection of N1 nodes, as well as nodes along the left gastric artery, common hepatic artery, celiac axis, splenic hilum, and splenic artery, as well as a distal pancreatectomy and splenectomy. Because there is evidence of a trend towards improved survival when patients do not undergo resection of the pancreas or spleen (Jiang et al., Br J Surg 2014), prophylactic pancreatectomy is not recommended, and splenectomy should be considered only when disease involves the spleen or its hilum. Therefore, current NCCN guidelines recommend either a D1 resection or a modified D2 resection, with a goal of examining ≥15 lymph nodes.

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