Skip to main content
Springer Nature Link
Log in

Lymphadenectomy Considerations Beyond Standard Gastrectomy

  • Gastrointestinal Oncology
  • Published:
Save article
View saved research
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Lymphadenectomy (LND) is a critical component of gastrectomy in curative multimodality treatment for gastric cancer (GC). Although its role in standard gastrectomy is well-established, its utility in non-standard scenarios remains uncertain. This review discusses the role of LND in unique contexts, including conversion surgery (CS), cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC), gastroesophageal junction (GEJ) cancers, early GC, emergency gastrectomy, remnant gastric cancer (RGC), microsatellite instable-high (MSI-H) tumors, cancer predisposition syndromes, gastric neuroendocrine tumors (g-NETs), gastric gastrointestinal stromal tumors (g-GISTs), and other rare gastric tumors. There is a lack of evidence regarding the extent of LND during CS and CRS/HIPEC for oligometastatic GC. Decisions should be individualized based on radiographic nodal involvement, patient factors, and clinical judgment. For GEJ cancers, the optimal extent of LND depends on the Siewert classification and the length of esophageal tumor invasion. Limited LND is often used in emergent settings, highlighting the need for studies evaluating the long-term impact of suboptimal LND and staged approaches. Unique lymphatic drainage patterns in RGC necessitate tailored LND, including D2, splenic hilum, and jejunal mesentery nodal basins. Lymphadenectomy remains critical for accurate staging and optimal outcomes in MSI-H tumors despite the favorable prognosis. Prophylactic LND in cancer predisposition syndromes should be guided by syndrome-specific risks. Treatment with D1 LND is recommended for gastric neuroendocrine carcinoma (g-NEC), g-NET with lymphadenopathy, and grade 3 disease. Lymphadenectomy generally is unnecessary for g-GIST, except for those with persistent lymphadenopathy after neoadjuvant therapy or uncommon mutations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+
from $39.99 /Month
  • Starting from 10 chapters or articles per month
  • Access and download chapters and articles from more than 300k books and 2,500 journals
  • Cancel anytime
View plans

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig 1
The alternative text for this image may have been generated using AI.
Fig. 2
The alternative text for this image may have been generated using AI.

Credit: Dr.Dehal

Similar content being viewed by others

Explore related subjects

Discover the latest articles, books and news in related subjects, suggested using machine learning.

References

  1. National Cancer Institute’s Epidemiology and End Results Program. Cancer Stat Facts: Stomach Cancer 2024. https://seer.cancer.gov/statfacts/html/stomach.html. Accessed 27 Mar

  2. Al-Batran SE, Homann N, Pauligk C, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019;393:1948–57. https://doi.org/10.1016/s0140-6736(18)32557-1.

    Article  PubMed  Google Scholar 

  3. Japanese Gastric Cancer Treatment Guidelines 2018. 5th edn. Gastric Cancer. 2021;24:1–21. https://doi.org/10.1007/s10120-020-01042-y.

  4. Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11–20. https://doi.org/10.1056/NEJMoa055531.

    Article  CAS  PubMed  Google Scholar 

  5. Japanese Gastric Cancer Treatment Guidelines 2021. 6th edn. Gastric Cancer. 2023;26:1–25. https://doi.org/10.1007/s10120-022-01331-8.

  6. Memon MA, Subramanya MS, Khan S, Hossain MB, Osland E, Memon B. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Ann Surg. 2011;253:900–11. https://doi.org/10.1097/SLA.0b013e318212bff6.

    Article  PubMed  Google Scholar 

  7. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11:439–49. https://doi.org/10.1016/s1470-2045(10)70070-x.

    Article  PubMed  Google Scholar 

  8. Wu CW, Hsiung CA, Lo SS, et al. Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol. 2006;7:309–15. https://doi.org/10.1016/s1470-2045(06)70623-4.

    Article  CAS  PubMed  Google Scholar 

  9. Degiuli M, Sasako M, Ponti A, et al. Randomized clinical trial comparing survival after D1 or D2 gastrectomy for gastric cancer. Br J Surg. 2014;101:23–31. https://doi.org/10.1002/bjs.9345.

    Article  CAS  PubMed  Google Scholar 

  10. Al-Batran SE, Homann N, Pauligk C, et al. Effect of neoadjuvant chemotherapy followed by surgical resection on survival in patients with limited metastatic gastric or gastroesophageal junction cancer: the AIO-FLOT3 trial. JAMA Oncol. 2017;3:1237–44. https://doi.org/10.1001/jamaoncol.2017.0515.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Cui Y, Yu Y, Zheng S, et al. Does resection after neoadjuvant chemotherapy of docetaxel, oxaliplatin, and S-1 (DOS regimen) benefit for gastric cancer patients with single non-curable factor? A multicenter, prospective cohort study (Neo-REGATTA). BMC Cancer. 2023;23:308. https://doi.org/10.1186/s12885-023-10773-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Brown ZJ, Hernandez JM, Ripley RT, Davis JL. Heated intraperitoneal chemotherapy and gastrectomy for gastric cancer in the U.S.: the time is now. J Gastrointest Oncol. 2017;8:1109–13. https://doi.org/10.21037/jgo.2017.09.01.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Badgwell B, Ikoma N, Murphy MB, et al. A phase II trial of cytoreduction, gastrectomy, and hyperthermic intraperitoneal perfusion with chemotherapy for patients with gastric cancer and carcinomatosis or positive cytology. Ann Surg Oncol. 2021;28:258–64. https://doi.org/10.1245/s10434-020-08739-5.

    Article  PubMed  Google Scholar 

  14. Green BL, Blumenthaler AN, Gamble LA, et al. Cytoreduction and HIPEC for gastric carcinomatosis: multi-institutional analysis of two phase II clinical trials. Ann Surg Oncol. 2023;30:1852–60. https://doi.org/10.1245/s10434-022-12761-0.

    Article  PubMed  Google Scholar 

  15. Bonnot PE, Piessen G, Kepenekian V, et al. Cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for gastric cancer with peritoneal metastases (CYTO-CHIP study): a propensity score analysis. J Clin Oncol. 2019;37:2028–40. https://doi.org/10.1200/JCO.18.01688.

    Article  CAS  PubMed  Google Scholar 

  16. Fujitani K, Yang HK, Mizusawa J, et al. Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trial. Lancet Oncol. 2016;17:309–18. https://doi.org/10.1016/S1470-2045(15)00553-7.

    Article  CAS  PubMed  Google Scholar 

  17. Wang Y, Zhu L, Xia W, Wang F. Anatomy of lymphatic drainage of the esophagus and lymph node metastasis of thoracic esophageal cancer. Cancer Manag Res. 2018;10:6295–303. https://doi.org/10.2147/cmar.S182436.

    Article  PubMed  PubMed Central  Google Scholar 

  18. van der Wilk BJ, Eyck BM, Wijnhoven BPL, et al. Neoadjuvant chemoradiotherapy followed by active surveillance versus standard surgery for oesophageal cancer (SANO trial): a multicentre, stepped-wedge, cluster-randomised, non-inferiority, phase 3 trial. Lancet Oncol. 2025;26:425–36. https://doi.org/10.1016/s1470-2045(25)00027-0.

    Article  CAS  PubMed  Google Scholar 

  19. Feith M, Stein HJ, Siewert JR. Adenocarcinoma of the esophagogastric junction: surgical therapy based on 1602 consecutive resected patients. Surg Oncol Clin North Am. 2006;15:751–64. https://doi.org/10.1016/j.soc.2006.07.015.

    Article  Google Scholar 

  20. Chen XD, Chen QC, Xu R, Zhao FZ. Therapeutic value of lymph node dissection for Siewert type II and III adenocarcinoma: meta-analysis. BJS Open. 2024. https://doi.org/10.1093/bjsopen/zrad138.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kurokawa Y, Hiki N, Yoshikawa T, et al. Mediastinal lymph node metastasis and recurrence in adenocarcinoma of the esophagogastric junction. Surgery. 2015;157:551–5. https://doi.org/10.1016/j.surg.2014.08.099.

    Article  PubMed  Google Scholar 

  22. Kurokawa Y, Takeuchi H, Doki Y, et al. Mapping of lymph node metastasis from esophagogastric junction tumors: a prospective nationwide multicenter study. Ann Surg. 2021;274:120–7. https://doi.org/10.1097/sla.0000000000003499.

    Article  PubMed  Google Scholar 

  23. Vos EL, Nakauchi M, Gönen M, et al. Risk of lymph node metastasis in T1b gastric cancer: an international comprehensive analysis from the Global Gastric Group (G3) Alliance. Ann Surg. 2023;277:e339–45. https://doi.org/10.1097/sla.0000000000005332.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Yu Z, Liang C, Gao J, et al. Clinicopathologic factors correlated with lymph node metastasis in gastric cancer: a retrospective cohort study involving 5606 patients. J Gastrointest Surg. 2024;28:1242–9. https://doi.org/10.1016/j.gassur.2024.05.014.

    Article  PubMed  Google Scholar 

  25. Fei H, Ren H, Wen Z, et al. Lymph node metastasis frequency and development of predictive model in T1b gastric cancer: a single-center study. Ann Surg Oncol. 2026;33:1391–403. https://doi.org/10.1245/s10434-025-18613-x.

    Article  PubMed  Google Scholar 

  26. Du M, Chen L, Cheng Y, et al. Tumor budding and other risk factors of lymph node metastasis in submucosal early gastric carcinoma: a multicenter clinicopathologic study in 621 radical gastrectomies of Chinese patients. Am J Surg Pathol. 2019;43:1074–82. https://doi.org/10.1097/pas.0000000000001276.

    Article  PubMed  Google Scholar 

  27. Yu W, Xu Z, Li B, et al. Nomogram for pre-procedural prediction of lymph node metastasis in patients with submucosal early gastric cancer. Surg Endosc. 2025;39:1661–71. https://doi.org/10.1007/s00464-024-11517-z.

    Article  PubMed  Google Scholar 

  28. Zhang M, Ding C, Xu L, et al. A nomogram to predict risk of lymph node metastasis in early gastric cancer. Sci Rep. 2021;11:22873. https://doi.org/10.1038/s41598-021-02305-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Kim YW, Min JS, Yoon HM, et al. Laparoscopic sentinel node navigation surgery for stomach preservation in patients with early gastric cancer: a randomized clinical trial. J Clin Oncol. 2022;40:2342–51. https://doi.org/10.1200/jco.21.02242.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Hur H, Lee YJ, Kim YW, et al. Clinical efficacy of laparoscopic sentinel node navigation surgery for stomach preservation in patients with early gastric cancer: 5-year results of the SENORITA trial. Ann Surg. 2024. https://doi.org/10.1097/sla.0000000000006219.

    Article  PubMed  Google Scholar 

  31. Eom BW, Yoon HM, Kim YW, et al. Quality of life and nutritional outcomes of stomach-preserving surgery for early gastric cancer: a secondary analysis of the SENORITA randomized clinical trial. JAMA Surg. 2024;159:900–8. https://doi.org/10.1001/jamasurg.2024.1210.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Blackshaw GR, Stephens MR, Lewis WG, Paris HJ, Barry JD, Edwards P, Allison MC. Prognostic significance of acute presentation with emergency complications of gastric cancer. Gastric Cancer. 2004;7:91–6. https://doi.org/10.1007/s10120-004-0274-7.

    Article  PubMed  Google Scholar 

  33. Vasas P, Wiggins T, Chaudry A, Bryant C, Hughes FS. Emergency presentation of the gastric cancer; prognosis and implications for service planning. World J Emerg Surg. 2012;7:31. https://doi.org/10.1186/1749-7922-7-31.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Tan KK, Quek TJ, Wong N, Li KK, Lim KH. Emergency surgery for perforated gastric malignancy: an institution’s experience and review of the literature. J Gastrointest Oncol. 2011;2:13–8. https://doi.org/10.3978/j.issn.2078-6891.2011.001.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Adachi Y, Mori M, Maehara Y, Matsumata T, Okudaira Y, Sugimachi K. Surgical results of perforated gastric carcinoma: an analysis of 155 Japanese patients. Am J Gastroenterol. 1997;92:516–8.

    CAS  PubMed  Google Scholar 

  36. Lehnert T, Buhl K, Dueck M, Hinz U, Herfarth C. Two-stage radical gastrectomy for perforated gastric cancer. Eur J Surg Oncol. 2000;26:780–4. https://doi.org/10.1053/ejso.2000.1003.

    Article  CAS  PubMed  Google Scholar 

  37. Ubøe AAS, Våge C, Mjønes P, Bringeland EA, Fossmark R. Gastric remnant cancer and long-term survival in central Norway 2001 to 2016: a population-based study. Surg Oncol. 2023;51:102008. https://doi.org/10.1016/j.suronc.2023.102008.

    Article  PubMed  Google Scholar 

  38. Ohira M, Toyokawa T, Sakurai K, et al. Current status in remnant gastric cancer after distal gastrectomy. World J Gastroenterol. 2016;22:2424–33. https://doi.org/10.3748/wjg.v22.i8.2424.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Li F, Zhang R, Liang H, Liu H, Quan J, Zhao J. The pattern of lymph node metastasis and the suitability of 7th UICC N stage in predicting prognosis of remnant gastric cancer. J Cancer Res Clin Oncol. 2012;138:111–7. https://doi.org/10.1007/s00432-011-1034-9.

    Article  CAS  PubMed  Google Scholar 

  40. Irino T, Hiki N, Ohashi M, Nunobe S, Tokunaga M, Sano T, Yamaguchi T. Characteristics of gastric stump cancer: a single hospital retrospective analysis of 262 patients. Surgery. 2016;159:1539–47. https://doi.org/10.1016/j.surg.2016.01.003.

    Article  PubMed  Google Scholar 

  41. Katai H, Ishikawa T, Akazawa K, et al. Optimal extent of lymph node dissection for remnant advanced gastric carcinoma after distal gastrectomy: a retrospective analysis of more than 3000 patients from the nationwide registry of the Japanese Gastric Cancer Association. Gastric Cancer. 2020;23:1091–101. https://doi.org/10.1007/s10120-020-01081-5.

    Article  PubMed  Google Scholar 

  42. Di Leo A, Pedrazzani C, Bencivenga M, et al. Gastric stump cancer after distal gastrectomy for benign disease: clinicopathological features and surgical outcomes. Ann Surg Oncol. 2014;21:2594–600. https://doi.org/10.1245/s10434-014-3633-6.

    Article  PubMed  Google Scholar 

  43. Komatsu S, Ichikawa D, Okamoto K, et al. Differences of the lymphatic distribution and surgical outcomes between remnant gastric cancers and primary proximal gastric cancers. J Gastrointest Surg. 2012;16:503–8. https://doi.org/10.1007/s11605-011-1804-3.

    Article  PubMed  Google Scholar 

  44. Janjigian YY, Shitara K, Moehler M, et al. First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial. Lancet. 2021;398:27–40. https://doi.org/10.1016/S0140-6736(21)00797-2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Kang YK, Boku N, Satoh T, et al. Nivolumab in patients with advanced gastric or gastro-oesophageal junction cancer refractory to, or intolerant of, at least two previous chemotherapy regimens (ONO-4538-12, ATTRACTION-2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017;390:2461–71. https://doi.org/10.1016/S0140-6736(17)31827-5.

    Article  CAS  PubMed  Google Scholar 

  46. Kato K, Shah MA, Enzinger P, et al. KEYNOTE-590: phase III study of first-line chemotherapy with or without pembrolizumab for advanced esophageal cancer. Future Oncol. 2019;15:1057–66. https://doi.org/10.2217/fon-2018-0609.

    Article  CAS  PubMed  Google Scholar 

  47. Kim R, An M, Lee H, et al. Early tumor-immune microenvironmental remodeling and response to first-line fluoropyrimidine and platinum chemotherapy in advanced gastric cancer. Cancer Discov. 2022;12:984–1001. https://doi.org/10.1158/2159-8290.CD-21-0888.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Cancer Genome Atlas Research N. Comprehensive molecular characterization of gastric adenocarcinoma. Nature. 2014;513:202–9. https://doi.org/10.1038/nature13480.

  49. Smyth EC, Wotherspoon A, Peckitt C, et al. Mismatch repair deficiency, microsatellite instability, and survival: an exploratory analysis of the Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial. JAMA Oncol. 2017;3:1197–203. https://doi.org/10.1001/jamaoncol.2016.6762.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Marrelli D, Polom K, Pascale V, et al. Strong prognostic value of microsatellite instability in intestinal type non-cardia gastric cancer. Ann Surg Oncol. 2016;23:943–50. https://doi.org/10.1245/s10434-015-4931-3.

    Article  PubMed  Google Scholar 

  51. Vos EL, Maron SB, Krell RW, et al. Survival of locally advanced MSI-high gastric cancer patients treated with perioperative chemotherapy: a retrospective cohort study. Ann Surg. 2023;277:798–805. https://doi.org/10.1097/SLA.0000000000005501.

    Article  PubMed  Google Scholar 

  52. Talari FF, Bozorg A, Zeinali S, Zali M, Mohsenifar Z, AsadzadehAghdaei H, Baghaei K. Low incidence of microsatellite instability in gastric cancers and its association with the clinicopathological characteristics: a comparative study. Sci Rep. 2023;13:21743. https://doi.org/10.1038/s41598-023-48157-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Choi YY, Kim H, Shin SJ, et al. Microsatellite instability and programmed cell death-ligand 1 expression in stage II/III gastric cancer: post hoc analysis of the CLASSIC randomized controlled study. Ann Surg. 2019;270:309–16. https://doi.org/10.1097/SLA.0000000000002803.

    Article  PubMed  Google Scholar 

  54. Kim W, Kidambi T, Lin J, Idos G. Genetic syndromes associated with gastric cancer. Gastrointest Endosc Clin North Am. 2022;32:147–62. https://doi.org/10.1016/j.giec.2021.08.004.

    Article  Google Scholar 

  55. Hatton JN, de Andrade KC, Frone MN, Savage SA, Khincha PP. Spectrum and excess risk of gastrointestinal tumors in Li-Fraumeni syndrome. Clin Gastroenterol Hepatol. 2024;22:662–5. https://doi.org/10.1016/j.cgh.2023.08.028.

    Article  PubMed  Google Scholar 

  56. Edwards P, Monahan KJ. Diagnosis and management of Lynch syndrome. Frontline Gastroenterol. 2022;13:e80–7. https://doi.org/10.1136/flgastro-2022-102123.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Kumar S, Farha N, Burke CA, Katona BW. Upper gastrointestinal cancer surveillance in Lynch syndrome. Cancers Basel. 2022. https://doi.org/10.3390/cancers14041000.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Blair VR, McLeod M, Carneiro F, et al. Hereditary diffuse gastric cancer: updated clinical practice guidelines. Lancet Oncol. 2020;21:e386–97. https://doi.org/10.1016/S1470-2045(20)30219-9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Garcia-Pelaez J, Barbosa-Matos R, Sao Jose C, et al. Gastric cancer genetic predisposition and clinical presentations: established heritable causes and potential candidate genes. Eur J Med Genet. 2022;65:104401. https://doi.org/10.1016/j.ejmg.2021.104401.

    Article  CAS  PubMed  Google Scholar 

  60. Gamble LA, Heller T, Davis JL. Hereditary diffuse gastric cancer syndrome and the role of CDH1: a review. JAMA Surg. 2021;156:387–92. https://doi.org/10.1001/jamasurg.2020.6155.

    Article  PubMed  Google Scholar 

  61. Foretova L, Navratilova M, Svoboda M, et al. GAPPS–gastric adenocarcinoma and proximal polyposis of the stomach syndrome in 8 families tested at Masaryk Memorial Cancer Institute: prevention and prophylactic gastrectomies. Klin Onkol. 2019;32(2):109–17. https://doi.org/10.14735/amko2019S109.

    Article  PubMed  Google Scholar 

  62. Iwatsuki M, Matsumoto C, Mimori K, Baba H. The comprehensive review of gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS) from diagnosis and treatment. Ann Gastroenterol Surg. 2023;7:725–32. https://doi.org/10.1002/ags3.12708.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Bryant MK, Sillcox R, Grady WM, Oelschlager BK. Laparoscopic prophylactic total gastrectomy with limited lymphadenectomy for CDH1 gene carriers. Surg Endosc. 2023;37:9373–80. https://doi.org/10.1007/s00464-023-10303-7.

    Article  PubMed  Google Scholar 

  64. Gallanis AF, Gamble LA, Samaranayake SG, et al. Costs of cancer prevention: physical and psychosocial sequelae of risk-reducing total gastrectomy. J Clin Oncol. 2024;42:421–30. https://doi.org/10.1200/JCO.23.01238.

    Article  PubMed  Google Scholar 

  65. DelleFave G, O’Toole D, Sundin A, et al. ENETS consensus guidelines update for gastroduodenal neuroendocrine neoplasms. Neuroendocrinology. 2016;103:119–24. https://doi.org/10.1159/000443168.

    Article  CAS  Google Scholar 

  66. Koseoglu H, Duzenli T, Sezikli M. Gastric neuroendocrine neoplasms: a review. World J Clin Cases. 2021;9:7973–85. https://doi.org/10.12998/wjcc.v9.i27.7973.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Shah MH, Goldner WS, Benson AB, et al. Neuroendocrine and adrenal tumors, version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021;19:839–68. https://doi.org/10.6004/jnccn.2021.0032.

    Article  CAS  PubMed  Google Scholar 

  68. Laird AM, Libutti SK. Management of other gastric and duodenal neuroendocrine tumors. Surg Oncol Clin North Am. 2020;29:253–66. https://doi.org/10.1016/j.soc.2019.11.009.

    Article  Google Scholar 

  69. Liu L, Liu W, Jia Z, et al. Application of machine-learning algorithms to predict lymph node metastasis in gastric neuroendocrine neoplasms. Heliyon. 2023;9:e20928. https://doi.org/10.1016/j.heliyon.2023.e20928.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Yamagata Y, Yoshikawa T, Ishizu K, et al. Is lymph node dissection for neuroendocrine carcinoma of the stomach effective as it is for adenocarcinoma? Eur J Surg Oncol. 2021;47:2004–9. https://doi.org/10.1016/j.ejso.2020.12.015.

    Article  PubMed  Google Scholar 

  71. Stiles ZE, Fleming AM, Dickson PV, Tsao M, Glazer ES, Shibata D, Deneve JL. Lymph node metastases in gastrointestinal stromal tumors: an uncommon event. Ann Surg Oncol. 2022;29:8641–8. https://doi.org/10.1245/s10434-022-12582-1.

    Article  PubMed  Google Scholar 

  72. von Mehren M, Kane JM, Riedel RF, et al. NCCN guidelines(R) insights: gastrointestinal stromal tumors, version 2.2022. J Natl Compr Canc Netw. 2022;20:1204–14. https://doi.org/10.6004/jnccn.2022.0058.

    Article  CAS  Google Scholar 

  73. Valadão M, de Mello EL, Lourenço L, Vilhena B, Romano S, Castro Ldos S. What is the prognostic significance of metastatic lymph nodes in GIST? Hepatogastroenterology. 2008;55:471–4.

    PubMed  Google Scholar 

  74. Boikos SA, Pappo AS, Killian JK, et al. Molecular subtypes of KIT/PDGFRA wild-type gastrointestinal stromal tumors: a report from the National Institutes of Health Gastrointestinal Stromal Tumor Clinic. JAMA Oncol. 2016;2:922–8. https://doi.org/10.1001/jamaoncol.2016.0256.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Miettinen M, Killian JK, Wang ZF, et al. Immunohistochemical loss of succinate dehydrogenase subunit A (SDHA) in gastrointestinal stromal tumors (GISTs) signals SDHA germline mutation. Am J Surg Pathol. 2013;37:234–40. https://doi.org/10.1097/PAS.0b013e3182671178.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Neppala P, Banerjee S, Fanta PT, Yerba M, Porras KA, Burgoyne AM, Sicklick JK. Current management of succinate dehydrogenase-deficient gastrointestinal stromal tumors. Cancer Metastasis Rev. 2019;38:525–35. https://doi.org/10.1007/s10555-019-09818-0.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  77. Board PDQATE. Gastrointestinal Stromal Tumors Treatment (PDQ®): Health Professional Version. PDQ Cancer Information Summaries. National Cancer Institute (US); 2002.

  78. Al-Akwaa AM, Siddiqui N, Al-Mofleh IA. Primary gastric lymphoma. World J Gastroenterol. 2004;10:5–11. https://doi.org/10.3748/wjg.v10.i1.5.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Ikoma N, Badgwell BD, Mansfield PF. Multimodality treatment of gastric lymphoma. Surg Clin North Am. 2017;97:405–20. https://doi.org/10.1016/j.suc.2016.11.012.

    Article  PubMed  Google Scholar 

  80. Ghimire P, Wu GY, Zhu L. Primary gastrointestinal lymphoma. World J Gastroenterol. 2011;17:697–707. https://doi.org/10.3748/wjg.v17.i6.697.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Yoon SS, Coit DG, Portlock CS, Karpeh MS. The diminishing role of surgery in the treatment of gastric lymphoma. Ann Surg. 2004;240:28–37. https://doi.org/10.1097/01.sla.0000129356.81281.0c.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Ko YH, Han JJ, Noh JH, Ree HJ. Lymph nodes in gastric B-cell lymphoma: pattern of involvement and early histological changes. Histopathology. 2002;40:497–504. https://doi.org/10.1046/j.1365-2559.2002.01411.x.

    Article  CAS  PubMed  Google Scholar 

  83. Fleming ID, Mitchell S, Dilawari RA. The role of surgery in the management of gastric lymphoma. Cancer. 1982;49:1135–41. https://doi.org/10.1002/1097-0142(19820315)49:6%3c1135::aid-cncr2820490612%3e3.0.co;2-e.

    Article  CAS  PubMed  Google Scholar 

  84. Rossi D, Bertoni F, Zucca E. Marginal-zone lymphomas. N Engl J Med. 2022;386:568–81. https://doi.org/10.1056/NEJMra2102568.

    Article  CAS  PubMed  Google Scholar 

  85. Conlon KC, Casper ES, Brennan MF. Primary gastrointestinal sarcomas: analysis of prognostic variables. Ann Surg Oncol. 1995;2:26–31. https://doi.org/10.1007/bf02303698.

    Article  CAS  PubMed  Google Scholar 

  86. Lee YT. Leiomyosarcoma of the gastrointestinal tract: general pattern of metastasis and recurrence. Cancer Treat Rev. 1983;10:91–101. https://doi.org/10.1016/0305-7372(83)90007-5.

    Article  CAS  PubMed  Google Scholar 

  87. Mendes J, Viveiros F, Veiga M, Fazeres F, Vasconcelos E. Gastric leiomyosarcoma: a case report and literature review. Cureus. 2025;17:e94111. https://doi.org/10.7759/cureus.94111.

    Article  PubMed  PubMed Central  Google Scholar 

  88. Zaanan A, Didelot A, Broudin C, et al. Longitudinal circulating tumor DNA analysis during treatment of locally advanced resectable gastric or gastroesophageal junction adenocarcinoma: the PLAGAST prospective biomarker study. Nat Commun. 2025;16:6815. https://doi.org/10.1038/s41467-025-62056-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  89. Huffman BM, Aushev VN, Budde GL, et al. Analysis of circulating tumor DNA to predict risk of recurrence in patients with esophageal and gastric cancers. JCO Precis Oncol. 2022;6:e2200420. https://doi.org/10.1200/po.22.00420.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgement

Society of Surgical Oncology Gastrointestinal Disease Site Workgroup: Jeremey Davis, Mariam Eskander, Moshim Kukar, Richelle T. Williams, Sonia T. Orcutt.

Author information

Authors and Affiliations

  1. Department of General Surgery, Southern California Permanente Medical Group, Department of Clinical Sciences, Kaiser Permanente School of Medicine, Los Angeles, Panorama City, CA, USA

    Ahmed Dehal MD, MPH, FSSO

  2. Division of Surgical Oncology, Department of Surgery, Roger Williams Medical Center/Boston University School of Medicine, Providence, RI, USA

    Steve Kwon MD, MPH, FACS, FSSO

  3. Division of Hepato-Pancreato-Biliary and Gastrointestinal Surgical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Michail N. Mavros MD, FACS, FSSO

  4. Division of Surgical Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA

    Parisa Malekzadeh MD

  5. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Travis Grotz MD

  6. Department of Surgery, Northwestern University, Chicago, IL, USA

    Brett L. Ecker MD

  7. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Vivian E. Strong MD

Authors
  1. Ahmed Dehal MD, MPH, FSSO
    View author publications

    Search author on:PubMed Google Scholar

  2. Steve Kwon MD, MPH, FACS, FSSO
    View author publications

    Search author on:PubMed Google Scholar

  3. Michail N. Mavros MD, FACS, FSSO
    View author publications

    Search author on:PubMed Google Scholar

  4. Parisa Malekzadeh MD
    View author publications

    Search author on:PubMed Google Scholar

  5. Travis Grotz MD
    View author publications

    Search author on:PubMed Google Scholar

  6. Brett L. Ecker MD
    View author publications

    Search author on:PubMed Google Scholar

  7. Vivian E. Strong MD
    View author publications

    Search author on:PubMed Google Scholar

Consortia

Society of Surgical Oncology Gastrointestinal Disease Site Workgroup

  • Jeremey Davis
  • , Mariam Eskander
  • , Moshim Kukar
  • , Richelle T. William
  •  & Sonia T. Orcutt

Corresponding author

Correspondence to Ahmed Dehal MD, MPH, FSSO.

Ethics declarations

Disclosure

Dr. Vivian Strong reports the following conflicts: Astra Zeneca – speaking honoraria and DaVinci – one time consultant. Other coauthors report no relevant financial disclosures.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dehal, A., Kwon, S., Mavros, M.N. et al. Lymphadenectomy Considerations Beyond Standard Gastrectomy. Ann Surg Oncol (2026). https://doi.org/10.1245/s10434-026-19517-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Version of record:

  • DOI: https://doi.org/10.1245/s10434-026-19517-0

Keywords