According to the Japanese Classification of Gastric Carcinoma (JCGC), a D2 lymphadenectomy for a resectable gastric cancer of the mid-body (corpus) includes removal of which nodal stations that are NOT included in a D1 dissection?
- A Stations 7, 8a, 9, 11p, 12a (and 11d for upper-third tumors) ✓
- B Stations 1, 3, 4sa, 4sb, 4d, 5, 6
- C Stations 13, 14v, 16a2, 16b1
- D Stations 10, 110, 111, 112
Correct answer: A. Stations 7, 8a, 9, 11p, 12a (and 11d for upper-third tumors)
Explanation
D1 dissection removes perigastric nodes (Stations 1–6, ± 7 depending on tumor location). D2 dissection adds the celiac axis nodes: Station 7 (left gastric artery), 8a (anterior common hepatic artery), 9 (celiac axis), 11p (proximal splenic artery), and 12a (hepatoduodenal ligament). For upper-third tumors, 11d (distal splenic artery) and 10 (splenic hilum) may be added. Stations 13, 14, 16 are para-aortic nodes belonging to D3 (M1 disease). The DUTCH/MRC trial confirmed D2 provides superior locoregional control over D1 for resectable gastric cancer.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.