Open Surgery for Gastric Cancer: Distal Subtotal Gastrectomy with D2 Lymph Node Dissection

  • Ji Yeong An
  • Yoon Young Choi
  • Sung Hoon NohEmail author


Gastric cancer is a major cancer worldwide but particularly in East Asia, where two-thirds of the cases were reported. This area includes Korea, Japan, and China [1]. Gastrectomy with lymph node dissection has been a standard treatment for gastric cancer [2]. The rationale behind this treatment option is twofold. Small tumors should be excised as they will progress to large tumors and invade other organs. Second, surgical resection of the primary tumors should effectively reduce the risk of metastatic relapse [3]. Outcomes of surgical resection for early stage of gastric cancer are quite good, with a greater than 90% 5-year overall survival, even without adjuvant chemotherapy or radiotherapy [4]. These statistics highlight the important role of surgeons in the treatment of gastric cancer.

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  1. 1.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108. Scholar
  2. 2.
    Japanese Gastric Cancer A. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14(2):113–23. Scholar
  3. 3.
    Weinberg RA. The biology of cancer. 2nd ed. New York: Garland Science; 2014.Google Scholar
  4. 4.
    Kim HH, Han SU, Kim MC, Hyung WJ, Kim W, Lee HJ, et al. Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched Korean multicenter study. J Clin Oncol. 2014;32(7):627–33. Scholar
  5. 5.
    Cuschieri SA, Hanna GB. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma: let us move on to another era. Ann Surg. 2014;259(6):e90. Scholar
  6. 6.
    Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11(5):439–49. Scholar
  7. 7.
    Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, et al. D2 lymphadenectomy alone or with Para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008;359(5):453–62. Scholar
  8. 8.
    Wu CW, Hsiung CA, Lo SS, Hsieh MC, Chen JH, Li AF, et al. Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol. 2006;7(4):309–15. Scholar
  9. 9.
    Ajani JA, Bentrem DJ, Besh S, D’Amico TA, Das P, Denlinger C, et al. Gastric cancer, version 2.2013: featured updates to the NCCN guidelines. J Natl Compr Cancer Netw. 2013;11(5):531–46.CrossRefGoogle Scholar
  10. 10.
    Okines A, Verheij M, Allum W, Cunningham D, Cervantes A, Group EGW. Gastric cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(Suppl 5):v50–4. Scholar
  11. 11.
    Japanese Gastric Cancer A. Japanese classification of gastric carcinoma – 2nd English edition. Gastric Cancer. 1998;1(1):10–24. Scholar
  12. 12.
    Liebermann-Meffert D. The greater omentum. Anatomy, embryology, and surgical applications. Surg Clin North Am. 2000;80(1):275–93, xii.CrossRefGoogle Scholar
  13. 13.
    Hagiwara A, Takahashi T, Sawai K, Taniguchi H, Shimotsuma M, Okano S, et al. Milky spots as the implantation site for malignant cells in peritoneal dissemination in mice. Cancer Res. 1993;53(3):687–92.PubMedGoogle Scholar
  14. 14.
    Maruyama K, Okabayashi K, Kinoshita T. Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg. 1987;11(4):418–25.CrossRefGoogle Scholar
  15. 15.
    Hagiwara A, Sawai K, Sakakura C, Shirasu M, Ohgaki M, Yamasaki J, et al. Complete omentectomy and extensive lymphadenectomy with gastrectomy improves the survival of gastric cancer patients with metastases in the adjacent peritoneum. Hepato-Gastroenterology. 1998;45(23):1922–9.PubMedGoogle Scholar
  16. 16.
    Hirao M, Kurokawa Y, Fujita J, Imamura H, Fujiwara Y, Kimura Y, et al. Long-term outcomes after prophylactic bursectomy in patients with resectable gastric cancer: final analysis of a multicenter randomized controlled trial. Surgery. 2015;157(6):1099–105. Scholar
  17. 17.
    Imamura H, Kurokawa Y, Kawada J, Tsujinaka T, Takiguchi S, Fujiwara Y, et al. Influence of bursectomy on operative morbidity and mortality after radical gastrectomy for gastric cancer: results of a randomized controlled trial. World J Surg. 2011;35(3):625–30. Scholar
  18. 18.
    Son T, Hyung WJ, Kim JW, Kim HI, An JY, Cheong JH, et al. Anatomic extent of metastatic lymph nodes: still important for gastric cancer prognosis. Ann Surg Oncol. 2014;21(3):899–907. Scholar
  19. 19.
    Choi YY, An JY, Katai H, Seto Y, Fukagawa T, Okumura Y, et al. A lymph node staging system for gastric cancer: a hybrid type based on topographic and numeric systems. PLoS One. 2016;11(3):e0149555. PubMed PMID: 26967161; PubMed Central PMCID: PMC4788413.CrossRefPubMedPubMedCentralGoogle Scholar

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© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Ji Yeong An
    • 1
    • 2
  • Yoon Young Choi
    • 1
  • Sung Hoon Noh
    • 1
    • 3
    Email author
  1. 1.Department of Surgery, Yonsei University Health SystemYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  3. 3.Brain Korea 21 PLUS Project for Medical Science, Yonsei University Health SystemYonsei University College of MedicineSeoulRepublic of Korea

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