We would like to thank the editorial authors for commenting on “Is D2 laparoscopic gastrectomy essential for elderly patients with advanced gastric cancer? A propensity score matched analysis”.
This study demonstrated the possible association between D2 laparoscopic gastrectomy (LG) and increased complication rate and no survival benefit of D2 LG in elderly patients (1).
Feng et al. commented on perioperative chemotherapy for gastric cancer (GC) patients. Regarding neoadjuvant chemotherapy, we do not have solid evidence which can be applied to Japanese practice. Next, Japanese Gastric Cancer Treatment Guideline recommends adjuvant chemotherapy for patients with advancer GC based on the ACTS-GC study and the CLASSIC study. However, median age was 63 and 56 years in the ACTS-GC study and the CLASSIC study, respectively (2,3). In Japanese real world, adjuvant chemotherapy for elderly patients is performed at surgeon’s discretion. Therefore, I believed our cohort represented Japanese practice. As Feng et al. proposed, GC patients without adjuvant chemotherapy may need to be elaborated. However, only a few patients received adjuvant chemotherapy in this study. Our conclusion was not affected, if we excluded the patients who received adjuvant chemotherapy.
The optimal extent of lymph node (LN) dissection and the number of retrieved LNs are important factor to improve outcomes of GC patients. In our study, D1+ dissection was performed in almost all non-D2 cases. Our procedures of D1+ were sophisticated and high quality. That’s why there was no difference in the harvested LN number, leading to no significant differences in the OS and RFS.
The sample size was one of limitations in our study. We did not deny D2 dissection for elderly patients but suggest possibility that D2 dissection was not needed in all elderly patients with gastric cancer. I completely agree with your opinion that further more well-designed studies with a large sample size are still needed to further validate these findings.
Provenance and Peer Review: This article was commissioned by the editorial office, Journal of Gastrointestinal Oncology. The article did not undergo external peer review.
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- Sakaguchi M, Hosogi H, Kanaya S. Is D2 laparoscopic gastrectomy essential for elderly patients with advanced gastric cancer? A propensity score matched analysis. J Gastrointest Oncol 2022;13:67-76. [Crossref] [PubMed]
- Sakuramoto S, Sasako M, Yamaguchi T, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 2007;357:1810-20. [Crossref] [PubMed]
- Bang YJ, Kim YW, Yang HK, et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet 2012;379:315-21. [Crossref] [PubMed]