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The Current Status and Development of Lymph Node Dissection for Gastric Cancer

  • Chang-Ming Huang
  • Chao-Hui Zheng

Abstract

In 1962, according to the results concluding from specimens of gastric cancer, the Japanese Gastric Cancer Association produced the first edition of Japanese Classification of Gastric Carcinoma (JCGC), in which lymph nodes (LNs) associated with metastasis of gastric cancer (GC) were anatomically divided into groups. This clarified the gastric lymphatic circulation system in detail. The classification laid the theoretical foundation of systematic lymph node dissection for GC and also propelled its surgical treatment into a new era. Researchers in Japan had worked to ensure that the standard set by the JCGC realistically reflected the approach and extent of lymph node metastasis (LNM), to guide the reasonable extent of lymph node dissection. The JCGC has been steadily revised since 1962 with new understandings from continuously practices by Japanese researchers; they kept observing and summarizing the regularities of the distribution of positive metastatic LNs. In 2010 the 14th edition of the JCGC was published. It described the lymphatic system of the stomach from the perspective of anatomy and further revealed the regularity of LNM of GC and the method for evaluating the extent of LNM. Moreover, it established the integrated theoretical framework for systemic lymphadenectomy, in which the extent of lymph node dissection was verified by the stage of cancer. The TNM staging system of the Union for International Cancer Control (UICC) is another important international appraisal system for GC, which evaluates the extent of metastasis with only the number of metastatic LNs. It reflected the relationship between the number of metastatic LNs and the prognosis of the patient. However, with respect to the regularity of LNM, this system cannot reflect well. It can only be regarded as a way for assessing the postoperative outcomes but not as a guide for determining the extent of surgery. Therefore, controversies on the extent of lymphadenectomy for GC almost center on the JCGC.

Keywords

Lymphadenectomy gastric cancer laparoscopic surgery 

Supplementary material

Video 2.1

3D totally laparoscopic distal gastrectomy for early gastric cancer (delta-shaped gastroduodenostomy) (MP4 1819480 kb)

Video 2.2

3D totally laparoscopic total gastrectomy with D2 lymph node dissection for advanced gastric cancer (MP4 1918015 kb)

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Copyright information

© Springer Science+Business Media Dordrecht and People's Medical Publishing House 2015

Authors and Affiliations

  • Chang-Ming Huang
    • 1
  • Chao-Hui Zheng
    • 1
  1. 1.Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina

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