100. Magencarcinom: Gastrektomie de principe

Abstract

Among surgical modalities of the gastric cancer total gastrectomy de principe and histology-oriented strategy are under discussion. In our own procedure we prefer total gastrectomy combined with extended lymph node dissection as the operation of choice justified by the results obtained. But caused by the lack of controlled studies these results cannot be used as an evidence. Nevertheless an exact analysis of the own material can show only an incidence of 5-30% in which total gastrectomy de principe may be a too extensive procedure in regard to the oncological point of view, but even these cases have to be examined in a randomised clinical study.

Surgical treatment of gastric cancer: Retrospective survey of 1,704 operated cases with special reference to total gastrectomy as the operation of choice

“…Since Schlatter performed the first total gastrectomy in 1897, the extent of surgical resection in gastric carcinoma has been under discussion [4,10,12,14,16,18,[20][21][22]24,33,49]. A possible explanation for the lack of agreement even in regard to the value of total gastrectomy as the operation of choice is probably the lack of prospective data.…”

“…Nevertheless, these numbers had increased during the past 5 years, which may in part be due to an increased knowledge of tumor growth, but primarily due to Lauren's classification, which gives precise information on the different types of gastric carcinoma and the margins of clearance at the proximal resection lines. According to these studies, adequate proximal resection lines to ensure tumor-free margins of 4 cm in the intestinal and of 8 cm in the diffuse type, both measured in situ, were postulated [ 12,471. Taking into account these requirements together with the site of the lesions, the relevant number of potentially distal subtotal gastrectomies as well as that of essential total gastrectomies, in each case with curative intention, can be precisely described [22].…”

“…In particular, the postoperative morbidity and mortality for total gastrectomy (e.g., leakage of the proximal anastomoses as the most feared complication, severe reflux esophagitis, digestive problems) could be evidently reduced [8,10,16,18,. This is also true for the performance of extensive dissection of lymph nodes independent of different points of view: systematic lymphadenectomy as a basic condition for precise pathohistological staging or the direct way to improve the long-term prognosis [8,10,22,23,26,30,38,39].…”

“…Nevertheless, discussion concerning different surgical procedures in the treatment of gastric carcinoma must remain open because of the lack of multicentric or prospective studies. This crucial point is related to any surgical measures; independent of theoretical arguments as well as current individual therapeutic approaches, the decisive improvement of overall survival rates can only be achieved by the performance of an RO resection without microscopic or macroscopic residual tumor [1,8,12,22,28]. To reach this therapeutic goal, particularly in advanced stages of tumor development, efforts regarding multimodality treatments, such as surgery, chemotherapy, and/or radiation therapy, must be continued, as gastric carcinoma has been shown to be a chemosensitive tumor, even with the concept of preoperative (neoadjuvant) application of effective drug regimens [40][41][42].…”

Surgical Strategies for the Treatment of Gastric Cancer Considering Intraoperative Radiation Therapy

“…Since 80% of gastric carcinomas present in an ad vanced tumor stage and only one fourth is localized in the distal third of the stomach, total gastrectomy is the treat ment of choice [9][10][11][12]. Small tumors in the antrum of Laurén's intestinal type may be resected distally.…”