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January 2002. Review Article.
In 1936 Inoue published an anatomical study on the lymphatic system of the stomach. With this foundation Kodama and Yoshida conducted separate studies, using activated carbon particles, to demonstrate patterns of lymphatic drainage in GCs ( 1, 2, 3, 4 ).
The concept of ELND as an adjunct to aggressive gastric resections began in the 1930s, when Wangensteen at the University of Minnesota Hospital noted, on review of their patients, that there were no 5 years survivors of GC. During the next 3 decades, Wangensteen incorporated a more aggressive approach to the treatment of GC, including more radical gastric resections with ELND; the result was an improvement in overall 5 years survival to 17%.
In 1951, Mc Neer et al at MSKCC described the technical aspects of a radical extended lymphadenectomy for GC. Shortly thereafter, in 1953, Sunderland et al at MSKCC included a radical LND ( 1, 6, 7, 8 ).
However, entusiasm for ELND waned in the United States and Europe, as subsequent clinical trials revealed an increase in morbidity rates and the lack of a clear survival advantage; these clinical trials were confounded by a large proportion of patients with advanced stage of disease.
In contrast numerous retrospective studies in Japan demonstrated minimal morbidity rates and increased survival rates after ELND. As a result, the Japanese Research Society for the Study of Gastric Cancer ( JRSGC ) has consistently recommended an extended ( D2 ) dissection for the treatment of GC ( 1, 9 ).
A careful review of the literature comparing the results in Japan and Western countries is difficult to interpret and does not fully explain why patients with advanced disease have a better chance for long term survival in Japan.
1) Hong Jin Kim, Martin S Karpeh, Murray F Brennan. Standardization of the extent of lymphadenectomy for gastric cancer: impact on survival. Advances in Surgery, volume 35 2001, 203-223.
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