Annals of surgical oncology
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Curative resection (R0) is the treatment of choice for distal gastric cancer, but it is unclear whether this operation should include a total gastrectomy (TG) with splenectomy and extended (D2) lymph node dissection. A new concept was developed based on the fact that residual metastatic lymph nodes after a limited (D1) subtotal gastrectomy (SG) may be the source of fatal relapse. We conducted a prospective study on patients who had undergone a D2 TG to evaluate whether certain stations left behind after a D1 SG contain metastasis. ⋯ Our results suggest the necessity of D2 dissection, but not of TG with splenectomy, to achieve an R0 resection for patients with distal gastric carcinoma. A large prospective study based on our protocol and findings may clarify whether a D2 R0 resection would result in a survival benefit.