Gastric Cancer

  • Koshi KumagaiEmail author
  • Takeshi Sano


Lymph node metastasis is the most important prognostic factor in potentially curable gastric cancer. Since 2010 the TNM classifications and the Japanese classification have been harmonized in terms of the N-category determined with the number of metastatic lymph nodes and of the stage grouping.

The D-number to describe the extent of lymph node dissection in gastrectomy is used to be defined in accordance with lymph node groups based on the primary tumor location. In the third edition of the Japanese guidelines published in 2010, the lymph node stations to be dissected in D1, D1+, and D2 were newly defined for total or distal gastrectomy regardless of the tumor location.

The 15-year follow-up of the Dutch trial demonstrated that the locoregional recurrence rate was significantly lower in patients treated with D2 than D1, showing a survival benefit. Today the D2 procedure has been recommended in most guidelines for patients with resectable advanced gastric cancer. There are debates on an optimal extent of lymph node dissection in esophagogastric junction cancer or cancer with duodenal invasion.


Gastric cancer Lymph node metastasis Therapeutic value index Classification Guidelines 


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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Gastroenterological Surgery, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan

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