Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues
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...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-01-01
|
| Series: | Current Oncology |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1718-7729/30/1/67 |
| _version_ | 1797443943949926400 |
|---|---|
| author | Luigi Marano Ludovico Carbone Gianmario Edoardo Poto Valeria Restaino Stefania Angela Piccioni Luigi Verre Franco Roviello Daniele Marrelli |
| author_facet | Luigi Marano Ludovico Carbone Gianmario Edoardo Poto Valeria Restaino Stefania Angela Piccioni Luigi Verre Franco Roviello Daniele Marrelli |
| author_sort | Luigi Marano |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-09T13:04:25Z |
| format | Article |
| id | doaj.art-14abd6c3bb464258954f940baf1b437b |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-09T13:04:25Z |
| publishDate | 2023-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj.art-14abd6c3bb464258954f940baf1b437b2023-11-30T21:49:48ZengMDPI AGCurrent Oncology1198-00521718-77292023-01-0130187589610.3390/curroncol30010067Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious IssuesLuigi Marano0Ludovico Carbone1Gianmario Edoardo Poto2Valeria Restaino3Stefania Angela Piccioni4Luigi Verre5Franco Roviello6Daniele Marrelli7Unit of Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, 53100 Siena, ItalyUnit of Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, 53100 Siena, ItalyUnit of Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, 53100 Siena, ItalyUnit of Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, 53100 Siena, ItalyUnit of Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, 53100 Siena, ItalyUnit of Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, 53100 Siena, ItalyUnit of Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, 53100 Siena, ItalyUnit of Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, 53100 Siena, ItalyDespite 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.https://www.mdpi.com/1718-7729/30/1/67lymphadenectomygastric cancerneoadjuvant |
| spellingShingle | Luigi Marano Ludovico Carbone Gianmario Edoardo Poto Valeria Restaino Stefania Angela Piccioni Luigi Verre Franco Roviello Daniele Marrelli Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues Current Oncology lymphadenectomy gastric cancer neoadjuvant |
| title | Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues |
| title_full | Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues |
| title_fullStr | Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues |
| title_full_unstemmed | Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues |
| title_short | Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues |
| title_sort | extended lymphadenectomy for gastric cancer in the neoadjuvant era current status clinical implications and contentious issues |
| topic | lymphadenectomy gastric cancer neoadjuvant |
| url | https://www.mdpi.com/1718-7729/30/1/67 |
| work_keys_str_mv | AT luigimarano extendedlymphadenectomyforgastriccancerintheneoadjuvanteracurrentstatusclinicalimplicationsandcontentiousissues AT ludovicocarbone extendedlymphadenectomyforgastriccancerintheneoadjuvanteracurrentstatusclinicalimplicationsandcontentiousissues AT gianmarioedoardopoto extendedlymphadenectomyforgastriccancerintheneoadjuvanteracurrentstatusclinicalimplicationsandcontentiousissues AT valeriarestaino extendedlymphadenectomyforgastriccancerintheneoadjuvanteracurrentstatusclinicalimplicationsandcontentiousissues AT stefaniaangelapiccioni extendedlymphadenectomyforgastriccancerintheneoadjuvanteracurrentstatusclinicalimplicationsandcontentiousissues AT luigiverre extendedlymphadenectomyforgastriccancerintheneoadjuvanteracurrentstatusclinicalimplicationsandcontentiousissues AT francoroviello extendedlymphadenectomyforgastriccancerintheneoadjuvanteracurrentstatusclinicalimplicationsandcontentiousissues AT danielemarrelli extendedlymphadenectomyforgastriccancerintheneoadjuvanteracurrentstatusclinicalimplicationsandcontentiousissues |