The efficacy of extended lymphadenectomy in the surgical treatment of gastric cancer remains a source of considerable controversy in the surgical literature. The Japanese results that provide the most compelling data in support of extended, or D2, dissections have not been duplicated in trials performed in Western countries. Both stage migration and an evolving body of literature supporting less aggressive tumor biology for Asian gastric cancers partially explain the survival differences between East and West. While flaws in both the design and conduct of several of these clinical trials have been identified, the results of the Dutch and English randomized trials offer no justification for the routine use of D2 dissection, leaving open the possibility of a limited benefit for the subset of patients having stage II or IIIA disease.
Butler JA. D2.5 Dissection for Gastric Carcinoma—Invited Critique. Arch Surg. 2004;139(6):669. doi:10.1001/archsurg.139.6.669