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Current Oncology
Volume 30
Issue 1
10.3390/curroncol30010067
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Review

Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues

by
Luigi Marano
,
Ludovico Carbone
*,
Gianmario Edoardo Poto
,
Valeria Restaino
,
Stefania Angela Piccioni
,
Luigi Verre
,
Franco Roviello
and
Daniele Marrelli
Unit of Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2023, 30(1), 875-896; https://doi.org/10.3390/curroncol30010067
Submission received: 30 November 2022 / Revised: 5 January 2023 / Accepted: 6 January 2023 / Published: 8 January 2023
(This article belongs to the Special Issue Endoscopic Diagnosis and Treatment of Gastrointestinal Cancer)
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Abstract

Despite its decreasing incidence, gastric cancer remains an important global healthcare problem due to its overall high prevalence and high mortality rate. Since the MAGIC and FNLCC/FFCD trials, the neoadjuvant chemotherapy has been recommended throughout Europe in gastric cancer. Potential benefits of preoperative treatments include a higher rate of R0 resection achieved by downstaging the primary tumor, a likely effect on micrometastases and isolated tumor cells in the lymph nodes, and, as a result, improved cancer-related survival. Nevertheless, distortion of anatomical planes of dissection, interstitial fibrosis, and sclerotic tissue changes may increase surgical difficulty. The collection of at least twenty-five lymph nodes after neoadjuvant therapy would seem to ensure removal of undetectable node metastasis and reduce the likelihood of locoregional recurrence. It is not what you take but what you leave behind that defines survival. Therefore, para-aortic lymph node dissection is safe and effective after neoadjuvant chemotherapy, in both therapeutic and prophylactic settings. In this review, the efficacy of adequate lymph node dissection, also in a neoadjuvant setting, has been investigated in the key studies conducted to date on the topic.
Keywords: lymphadenectomy; gastric cancer; neoadjuvant lymphadenectomy; gastric cancer; neoadjuvant

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MDPI and ACS Style

Marano, L.; Carbone, L.; Poto, G.E.; Restaino, V.; Piccioni, S.A.; Verre, L.; Roviello, F.; Marrelli, D. Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues. Curr. Oncol. 2023, 30, 875-896. https://doi.org/10.3390/curroncol30010067

AMA Style

Marano L, Carbone L, Poto GE, Restaino V, Piccioni SA, Verre L, Roviello F, Marrelli D. Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues. Current Oncology. 2023; 30(1):875-896. https://doi.org/10.3390/curroncol30010067

Chicago/Turabian Style

Marano, Luigi, Ludovico Carbone, Gianmario Edoardo Poto, Valeria Restaino, Stefania Angela Piccioni, Luigi Verre, Franco Roviello, and Daniele Marrelli. 2023. "Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues" Current Oncology 30, no. 1: 875-896. https://doi.org/10.3390/curroncol30010067

APA Style

Marano, L., Carbone, L., Poto, G. E., Restaino, V., Piccioni, S. A., Verre, L., Roviello, F., & Marrelli, D. (2023). Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues. Current Oncology, 30(1), 875-896. https://doi.org/10.3390/curroncol30010067

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