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Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues

Despite its decreasing incidence, gastric cancer remains an important global healthcare problem due to its overall high prevalence and high mortality rate. Since the MAGIC and FNLCC/FFCD trials, the neoadjuvant chemotherapy has been recommended throughout Europe in gastric cancer. Potential benefits...

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Main Authors: Marano, Luigi, Carbone, Ludovico, Poto, Gianmario Edoardo, Restaino, Valeria, Piccioni, Stefania Angela, Verre, Luigi, Roviello, Franco, Marrelli, Daniele
Format: Online Article Text
Language:English
Published: MDPI 2023
Subjects:
Online Access:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9858164/
https://www.ncbi.nlm.nih.gov/pubmed/36661716
http://dx.doi.org/10.3390/curroncol30010067
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author Marano, Luigi
Carbone, Ludovico
Poto, Gianmario Edoardo
Restaino, Valeria
Piccioni, Stefania Angela
Verre, Luigi
Roviello, Franco
Marrelli, Daniele
author_facet Marano, Luigi
Carbone, Ludovico
Poto, Gianmario Edoardo
Restaino, Valeria
Piccioni, Stefania Angela
Verre, Luigi
Roviello, Franco
Marrelli, Daniele
author_sort Marano, Luigi
collection PubMed
description Despite its decreasing incidence, gastric cancer remains an important global healthcare problem due to its overall high prevalence and high mortality rate. Since the MAGIC and FNLCC/FFCD trials, the neoadjuvant chemotherapy has been recommended throughout Europe in gastric cancer. Potential benefits of preoperative treatments include a higher rate of R0 resection achieved by downstaging the primary tumor, a likely effect on micrometastases and isolated tumor cells in the lymph nodes, and, as a result, improved cancer-related survival. Nevertheless, distortion of anatomical planes of dissection, interstitial fibrosis, and sclerotic tissue changes may increase surgical difficulty. The collection of at least twenty-five lymph nodes after neoadjuvant therapy would seem to ensure removal of undetectable node metastasis and reduce the likelihood of locoregional recurrence. It is not what you take but what you leave behind that defines survival. Therefore, para-aortic lymph node dissection is safe and effective after neoadjuvant chemotherapy, in both therapeutic and prophylactic settings. In this review, the efficacy of adequate lymph node dissection, also in a neoadjuvant setting, has been investigated in the key studies conducted to date on the topic.
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spelling pubmed-98581642023-01-21 Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues Marano, Luigi Carbone, Ludovico Poto, Gianmario Edoardo Restaino, Valeria Piccioni, Stefania Angela Verre, Luigi Roviello, Franco Marrelli, Daniele Curr Oncol Review Despite its decreasing incidence, gastric cancer remains an important global healthcare problem due to its overall high prevalence and high mortality rate. Since the MAGIC and FNLCC/FFCD trials, the neoadjuvant chemotherapy has been recommended throughout Europe in gastric cancer. Potential benefits of preoperative treatments include a higher rate of R0 resection achieved by downstaging the primary tumor, a likely effect on micrometastases and isolated tumor cells in the lymph nodes, and, as a result, improved cancer-related survival. Nevertheless, distortion of anatomical planes of dissection, interstitial fibrosis, and sclerotic tissue changes may increase surgical difficulty. The collection of at least twenty-five lymph nodes after neoadjuvant therapy would seem to ensure removal of undetectable node metastasis and reduce the likelihood of locoregional recurrence. It is not what you take but what you leave behind that defines survival. Therefore, para-aortic lymph node dissection is safe and effective after neoadjuvant chemotherapy, in both therapeutic and prophylactic settings. In this review, the efficacy of adequate lymph node dissection, also in a neoadjuvant setting, has been investigated in the key studies conducted to date on the topic. MDPI 2023-01-08 /pmc/articles/PMC9858164/ /pubmed/36661716 http://dx.doi.org/10.3390/curroncol30010067 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Marano, Luigi
Carbone, Ludovico
Poto, Gianmario Edoardo
Restaino, Valeria
Piccioni, Stefania Angela
Verre, Luigi
Roviello, Franco
Marrelli, Daniele
Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues
title Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues
title_full Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues
title_fullStr Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues
title_full_unstemmed Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues
title_short Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues
title_sort extended lymphadenectomy for gastric cancer in the neoadjuvant era: current status, clinical implications and contentious issues
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9858164/
https://www.ncbi.nlm.nih.gov/pubmed/36661716
http://dx.doi.org/10.3390/curroncol30010067
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