[Current problems in surgical oncology 2. A lesson from Japan. D2 lymphadenectomy in gastric cancer].

At present there is accumulating evidence supporting the D2 lymphadenectomy in gastric cancer performed according the rules of the Japanese school of surgery. The D2 lymphadenectomy by open surgery seems to gain a wide acceptance and to become a standard therapy. The minimally invasive D2 lymphadenectomy (by laparoscopic or robotic surgery) in advanced gastric cancer showed promising results. However, these advanced minimally invasive techniques have still to be performed only in highly specialized surgical centers, with a large experience in oncological surgery. Further clinical trials are needed in order to verify the encouraging data of the few studies published until now in this field.