Standard D2 and Modified Nodal Dissection for Gastric Adenocarcinoma

The quality of surgical treatment is a major determinant of cancer treatment outcomes; however, controlling surgical quality is a difficult task. Surgical treatment of gastric cancers, and especially the benefits of nodal dissection, has been a topic of debate and no consensus has been reached to date. The D2 nodal dissection defined, standardized, and practiced in Japan is a technically challenging procedure but carries better locoregional disease control. This article reviews the current definition of D1, D1 plus, and D2 nodal dissections, as well as the nodal dissection technique, indications for its modification, and the learning curve.