Which lymph node dissection should be performed in advanced distal gastric cancer? A critical assessment of D2 lymphadenectomy

Table 1 Incidence of lymph node metastasis and index of estimated benefit from lymph node dissection in each station in lower third gastric cancer[86,87]

Lymph node station	Incidence of metastasis	Index of estimated benefit
1	6.2	1.6
2	7.1	0
3	40.9	17.3
4	34.2	14.5
5	10.5	3.9
6	46.3	21.3
7	23.4	8.2
8	24.5	7.5
9	12.8	3.9
10	3.8	0
11	6.7	1.0
12	9.0	2.7
13	8.3	0
14	14.6	2.1
16	13.1	2.4

Table 2 Extent of systematic lymphadenectomy according to the type of gastrectomy indicated[17]

Lymphadenectomy	Gastrectomy
	Total	Distal
D1	Lymph node stations Nos. 1, 2, 3, 4, 5, 6, and 7	Lymph node stations Nos. 1, 3, 4sb, 4d, 5, 6 and 7
D1+	D1 stations plus stations Nos. 8a, 9, and 11p	D1 stations plus stations Nos. 8a, and 9
D2	D1 stations plus stations Nos. 8a, 9, 10, 11p, 11d, and 12a	D1 stations plus stations Nos. 8a, 9, 11p, and 12a

Table 3 Lymph node groups to be resected for D1 and D2 lymphadenectomy according to clinical practice guidelines

Ref.		D1 lymphadenectomy	D2 lymphadenectomy	Type of gastrectomy
[68]	NCCN	Stations Nos. 1, 2, 3, 4, 5, 6	Stations Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11	Not specified
[66]	ESMO	Stations Nos. 1, 2, 3, 4, 5, 6, 7	Stations Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 11	Not specified
[17]	JGCA	Stations Nos. 1, 2, 3, 4, 5, 6, 7	Stations Nos. 1, 2, 3, 4, 5, 6, 7, 8a, 9, 10, 11p, 11d, 12	Total
		Stations Nos. 1, 3, 4sb, 4d, 5, 6, 7	Stations Nos. 1, 3, 4sb, 4d, 5, 6, 7, 8a, 9, 11p, 12a	Distal
[69]	Polish Consensus	Stations Nos. 1, 2, 3, 4, 5, 6, 7	Stations Nos. 1, 2, 3, 4, 5, 6, 7, 8a, 9, 11, 12a	Total
		Stations Nos. 1, 3, 4sb, 4d, 5, 6, 7	Stations Nos. 1, 3, 4sb, 4d, 5, 6, 7, 8a, 9, 11, 12a	Distal
[70]	Brazilian Group	Stations Nos. 1, 2, 3, 4, 5, 6	Stations Nos. 1, 2, 3, 4, 5, 6, 7, 8a, 9, 10, 11p, 11d	Not specified

NCCN: National Comprehensive Cancer Network; ESMO: European Society of Medical Oncology; JGCA: Japanese Gastric Cancer Association.