Gastric cancer with para-aortic lymph node metastases: do not miss a chance of cure!

This letter to editor is a comment to the paper by Wang et al. entitled: "A phase II trial of Xeloda and oxaliplatin (XELOX) neo-adjuvant chemotherapy followed by surgery for advanced gastric cancer patients with para-aortic lymph node metastasis". In a phase II trial, patients with primary gastric cancer and clinical involvement of para-aortic nodes (PAN) were treated by neo-adjuvant chemotherapy with capecitabine and oxaliplatin combination, and responders were then submitted to gastrectomy with D2 lymphadenectomy. The diagnostic and therapeutic approach adopted in this protocol is discussed, with special reference to the potential limits of computed tomography scan for the clinical diagnosis of PAN metastases (false positive results), and the opportunity to perform a D2 plus para-aortic lymphadenectomy, to further increase the chance of cure in patients with suspected PAN metastases.