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World J Gastrointest Surg. Mar 27, 2026; 18(3): 114895
Published online Mar 27, 2026. doi: 10.4240/wjgs.v18.i3.114895
Published online Mar 27, 2026. doi: 10.4240/wjgs.v18.i3.114895
Which lymph node dissection should be performed in advanced distal gastric cancer? A critical assessment of D2 lymphadenectomy
Giuseppe Brisinda, Gaia Altieri, Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
Giuseppe Brisinda, Filomena Misuriello, Edoardo Piras, Giada Bracalente, Department of Medicine and Surgery, Catholic School of Medicine, Rome 00168, Italy
Maria Michela Chiarello, Department of Surgery, Provincial Health Authority, Cosenza 87100, Italy
Maria Cariati, Department of Surgery, Provincial Health Authority, Crotone 88900, Italy
Giuseppe Tropeano, Department of General Surgery, Delta Hospital, Chirec Group, Brussels 1160, Brussels-Capital Region, Belgium
Valerio Papa, Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, “La Sapienza” University, Rome 00189, Italy
Author contributions: Brisinda G, Chiarello MM, and Papa V conceived the original idea; Misuriello F, Cariati M, Tropeano G, Piras E, Altieri G, and Bracalente G performed a comprehensive review of all available literature and synthesized the data. All authors wrote the manuscript, performed a critical appraisal of the manuscript, and read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Giuseppe Brisinda, MD, Professor, Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, No. 8 Largo Agostino Gemelli, Rome 00168, Italy. gbrisin@tin.it
Received: October 9, 2025
Revised: December 28, 2025
Accepted: January 21, 2026
Published online: March 27, 2026
Processing time: 178 Days and 3.8 Hours
Revised: December 28, 2025
Accepted: January 21, 2026
Published online: March 27, 2026
Processing time: 178 Days and 3.8 Hours
Core Tip
Core Tip: The extent of lymphadenectomy influences the prognosis in patients with distal gastric cancer. The most authoritative guidelines recommend a D2 lymphadenectomy in T2-T4 tumors, as well as T1N+, regardless of tumor location. The purpose of this review is to support the extension of lymph node dissection based on the existing literature. An analysis of the results is performed to assess the need for lymphadenectomy with removal of lymph nodes not included in the standard D2 lymphadenectomy in patients with distal gastric cancer, especially if the tumor is advanced.