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Effectiveness of extended lymphadenectomy in noncurative gastrectomy

To the Editor: We read with interest the paper by Dr. Baba and colleagues.’ The authors assessed significantly higher 5-year survival rate in noncurative advanced gastric cancer patients treated with extensive R2/3 lymphadenectomy (10%) compared to simple Rl-gastrectomy (2%). Because their conclusions are in contrast to those of our previous study,’ as well as with those of European studies,‘a4 we have some critical comments. The therapeutic benefit of systematic extensive (R2/3 ) lymph node dissection in patients with gastric cancer in Western countries is controversial. Many Japanese retrospective studies have shown impressive survival rates with R2/3 gastrectomy, but these results could not be reproduced in Western countries by several groups.2,5 Some other studies have found a suggestion of some benefit of extended lymphadenectomy in selected patients,3f4,6m” but the results were not as impressive as those from Japan. Especially in patients with advanced gastric carcinoma who underwent a noncurative resection, all data from western countries absolutely convince that extensive lymphadenectomy does not prolong survival and therefore should not be performed. 2m4In our previous report’ R2 resection did not increase morbidity or mortality but had no survival advantage compared with Rl gastrectomy. In a large multicentric German prospective nonrandomised trial,4 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The American Journal of Surgery Elsevier
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