Updates in Surgery

, Volume 70, Issue 2, pp 207–211 | Cite as

Para-aortic lymphadenectomy in surgery for gastric cancer: current indications and future perspectives

  • Valentina MengardoEmail author
  • Maria Bencivenga
  • Jacopo Weindelmayer
  • Michele Pavarana
  • Simone Giacopuzzi
  • Giovanni de Manzoni
Review Article
Part of the following topical collections:
  1. Gastric Cancer Surgery


Involvement of para-aortic nodes (PAN) has been detected at pathological examination in 10–25% of locally advanced gastric cancer. Based on these data of nodal diffusion, the lymphadenectomy of para-aortic stations would be desirable in locally advanced gastric cancer. However, the debate on the oncological benefit of para-aortic nodes dissection is still not solved. A review of the literature was performed and papers reporting either the rate of para-aortic nodal metastases or the long-term survival outcomes after D2+ para-aortic nodes dissection (PAND) or D3 lymphadenectomy were descriptively reported. The literature survey yielded 14 studies. Most of the papers show the outcome of series of advanced gastric cancer treated with surgery alone, while starting from 2012, 3 articles report the outcomes of D2 + PAND or D3 lymphadenectomy after preoperative chemotherapy. The rate of PAN metastases ranges between 8.5 and 28% in surgical series. Survival outcomes largely improved in series of patients treated with multimodal approach compared to those of surgery alone. In patients with clinically detected para-aortic nodal metastases, preoperative chemotherapy followed by PAND is indicated. More data are needed to clarify the indication to prophylactic PAND in the era of multimodal treatment, anyway super-extended lymphadenectomies have to be performed by experienced surgeons in dedicated centres.


Gastric cancer Lymphadenectomy Para-aortic lymphadenectomy 


Sources of financial support


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

The research does not involve Human Participants and/or Animals.

Informed consent

There was no need to get informed consent.


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Copyright information

© Italian Society of Surgery (SIC) 2018

Authors and Affiliations

  • Valentina Mengardo
    • 1
    Email author
  • Maria Bencivenga
    • 1
  • Jacopo Weindelmayer
    • 1
  • Michele Pavarana
    • 2
  • Simone Giacopuzzi
    • 1
  • Giovanni de Manzoni
    • 1
  1. 1.General and Upper GI Surgery DivisionUniversity of VeronaVeronaItaly
  2. 2.Department of Medical OncologyOspedale Civile Maggiore of VeronaVeronaItaly

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