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The treatment of operable gastric carcinoma has evolved in the last 30 years. A step-by-step evolution of surgical techniques is documented, starting from the en bloc resection of perigastric tissues, firstly by Billroth and finally by Whipple. In the 1980s the first randomized controlled trials confirmed the oncologic efficacy of a D2 lymphadenectomy in the treatment of gastric cancer. Nowadays, it is widely accepted that perigastric lymph nodes, along the celiac axis, the common hepatic artery and the para-aortic lymph nodes can be removed with a D2 radical lymphadenectomy and this may be associated with better overall survival. However, the oncological usefulness of this lymphadenectomy is still debated. In fact, as a surgical procedure it is associated with very high morbidity and mortality rates and the risk of local recurrence is still high. In addition, the prognostic significance of D2 lymphadenectomy on the long-term survival and/or the emergence of second tumours have not been proved yet. To better define the role of D2 lymphadenectomy in gastric cancer, further studies with new and validated diagnostic tools are needed.
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