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Extended lymph-node dissection in gastric cancer: standard, selective or unnecessary procedure?

The effectiveness of extended lymph-node dissection for patients with gastric cancer still remains unclear because favorable results reported by Japanese and some Western observational studies could not be confirmed by two recent European randomized trials. Because the surgeon's experience with extended node dissection and the node preservation of spleen and pancreas are predominant factors influencing survival, more data from well-designed and conducted randomized trials considering these variables are needed to establish whether extensive lymphadenectomy improves survival in gastric cancer patients.