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Invited Critique
August 2012

The End of Limited Lymphadenectomy in Gastroesophageal Cancer Surgery?Comment on “Improving Outcomes After Gastroesophageal Cancer Resection”

Author Affiliations

Author Affiliations: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.

Arch Surg. 2012;147(8):746. doi:10.1001/archsurg.2012.1015

Hanna et al1 report the result of a retrospective cohort study to evaluate outcomes after gastroesophageal surgery in Western patients. The authors conclude that a well-trained surgeon could perform extended lymphadenectomy safely and effectively. Two points should be considered when interpreting these data. First, stage migration is an issue in the stage-by-stage survival analysis compared with the Japanese data. Many patients in the authors' institution underwent neoadjuvant chemotherapy, whereas most of the Japanese patients received no treatment before surgery. Second, the proportion of patients undergoing gastrectomy who developed postoperative pneumonia (22.0%) was 10 times higher than that in the Japanese patients, although gastric cancer surgery seldom requires thoracotomy. Improvement of preoperative and postoperative management to prevent pulmonary complications is necessary.

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