Gastric cancer: Current status of lymph node dissection

Table 1 Numbering of lymph nodes according to the old classification of Japanese Research Society for Gastric Cancer (1962)

Station nr		Station nr
1	Right cardiac nodes	9	Nodes around the coeliac axis
2	Left cardiac nodes	10	Nodes at the splenic hilus
3	Nodes along the lesser curvature	11	Nodes along the splenic artery
4	Nodes along the greater curvature	12	Nodes in the hepatoduodenal ligament
5	Suprapyloric nodes	13	Nodes at the posterior aspect of the pancreas head
6	Infrapyloric nodes	14	Nodes at the root of the mesenterium
7	Nodes along the left gastric artery	15	Nodes in the mesocolon of the transverse colon
8	Nodes along the common hepatic artery	16	Para-aortic lymph nodes

Table 2 Anatomical definitions of lymph node stations

Nr.	Definition
1	Right paracardial LNs, including those along the first branch of the ascending limb of the left gastric artery
2	Left paracardial LNs including those along the esophagocardiac branch of the left subphrenic artery
3a	Lesser curvature LNs along the branches of the left gastric artery
3b	Lesser curvature LNs along the 2nd branch and distal part of the right gastric artery
4sa	Left greater curvature LNs along the short gastric arteries (perigastric area)
4sb	Left greater curvature LNs along the left gastroepiploic artery (perigastric area)
4d	Rt. greater curvature LNs along the 2nd branch and distal part of the right gastroepiploic artery
5	Suprapyloric LNs along the 1st branch and proximal part of the right gastric artery
6	Infrapyloric LNs along the first branch and proximal part of the right gastroepiploic artery down to the confluence of the right gastroepiploic vein and the anterior superior pancreatoduodenal vein
7	LNs along the trunk of left gastric artery between its root and the origin of its ascending branch
8a	Anterosuperior LNs along the common hepatic artery
8p	Posterior LNs along the common hepatic artery
9	Coeliac artery
10	Splenic hilar LNs including those adjacent to the splenic artery distal to the pancreatic tail, and those on the roots of the short gastric arteries and those along the left gastroepiploic artery proximal to its 1st gastric branch
11p	Proximal splenic artery LNs from its origin to halfway between its origin and the pancreatic tail end
11d	Distal splenic artery LNs from halfway between its origin and the pancreatic tail end to the end of the pancreatic tail
12a	Hepatoduodenal ligament LNs along the proper hepatic artery, in the caudal half between the confluence of the right and left hepatic ducts and the upper border of the pancreas
12b	Hepatoduodenal ligament LNs along the bile duct, in the caudal half between the confluence of the right and left hepatic ducts and the upper border of the pancreas
12p	Hepatoduodenal ligament LNs along the portal vein in the caudal half between the confluence of the right and left hepatic ducts and the upper border of the pancreas
13	LNs on the posterior surface of the pancreatic head cranial to the duodenal papilla
14v	LNs along the superior mesenteric vein
15	LNs along the middle colic vessels
16a1	Paraaortic LNs in the diaphragmatic aortic hiatus
16a2	Paraaortic LNs between the upper margin of the origin of the celiac artery and the lower border of the left renal vein
16b1	Paraaortic LNs between the lower border of the left renal vein and the upper border of the origin of the inferior mesenteric artery
16b2	Paraaortic LNs between the upper border of the origin of the inferior mesenteric artery and the aortic bifurcation
17	LNs on the anterior surface of the pancreatic head beneath the pancreatic sheath
18	LNs along the inferior border of the pancreatic body
19	Infradiaphragmatic LNs predominantly along the subphrenic artery
20	Paraesophageal LNs in the diaphragmatic esophageal hiatus
110	Paraesophageal LNs in the lower thorax
111	Supradiaphragmatic LNs separate from the esophagus
112	Posterior mediastinal LNs separate from the esophagus and the esophageal hiatus

LNs: Lymph nodes.

Table 3 Results of randomised controlled trials on D1 vs D2 gastrectomy

RCT	Nr. pts		Morbidity (%)		Mortality (%)		Survival (%)
	D1	D2	D1	D2	D1	D2	D1 (OS)	D2 (OS)
Bonenkamp et al[45,46]	380	331	25	43 P < 0.001	4	10 P = 0.04	45 (5 yr)	47 (5 yr) P = 0.99
							30 (11 yr)	35 (11 yr) P = 0.53
							21 (15 yr)	35 (15 yr) P = 0.03
Cuschieri et al[38,49]	200	200	28	46 P < 0.001	6.5	13 P = 0.04	35 (5 yr)	33 (5 yr) P = 0.43
Wu et al[55,56]	110	111	17.1	7.3 P = 0.012	0	0	59.5 (5 yr)	53.3 (5 yr) P = 0.041
Degiuli et al[18,58]	133	134	12	17.9 P = 0.178	3	2.2 P = 0.722	66.5 (5 yr)	64.2 (5 yr) P = 0.695
							38 (DSS 5 yr T2-T4 N+)	59.0 (DSS 5 yr T2-4 N+) P = 0.055

RCT: Randomised controlled trial; OS: Overall survival; DSS: Disease specific survival; N+: Node positive patients.