Lymph-Node Dissection for Gastric Cancer

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Abstract
In this issue of the Journal, Bonenkamp et al.1 report the results of a Dutch trial in which 711 patients with gastric cancer were randomly assigned to gastrectomy with either a limited (D1) lymph-node dissection (380 patients) or an extended (D2) lymph-node dissection (331 patients). The concept of extended lymph-node dissection was developed five decades ago, and there are claims based on historical data that extended surgical resection, especially extended lymph-node dissection, improves the outcome in gastric cancer.2 The procedure has lost favor, however, because of excessive morbidity and mortality. Nevertheless, it has continued to be the standard approach used . . .