Published online Dec 10, 2015. doi: 10.5306/wjco.v6.i6.291
Peer-review started: June 11, 2015
First decision: August 4, 2015
Revised: August 26, 2015
Accepted: September 25, 2015
Article in press: September 28, 2015
Published online: December 10, 2015
Processing time: 181 Days and 21.8 Hours
Gastric cancer with extensive lymph node metastasis (ELM) is usually considered unresectable and is associated with poor outcomes. Cases with clinical enlargement of the para-aortic lymph nodes and/or bulky lymph node enlargement around the celiac artery and its branches are generally dealt with as ELM. A standard treatment for gastric cancer with ELM has yet to be determined. Two phase II studies of neoadjuvant chemotherapy followed by surgery showed that neoadjuvant chemotherapy with S-1 plus cisplatin followed by surgical resection with extended lymph node dissection could represent a treatment option for gastric cancer with ELM. However, many clinical questions remain unresolved, including the criteria for diagnosing ELM, optimal regime, number of courses and extent of lymph node dissection.
Core tip: Gastric cancer with extensive lymph node metastasis (ELM) is usually considered unresectable and associated with poor outcomes. Phase II studies of neoadjuvant chemotherapy followed by surgery have shown the efficacy of this multimodal therapy for this pathology, but many clinical questions remain unresolved, including the criteria for diagnosing ELM, optimal regime, number of courses and extent of lymph node dissection.