Advances in the surgical management of gastric and gastroesophageal junction cancer

Abstract

Since Theodore Billroth and Cesar Roux perfected the methods of post-gastrectomy reconstruction in the late 19 th century, surgical management of gastric and gastroesophageal cancer has made incremental progress. The majority of patients with localized disease are treated with perioperative combination chemotherapy or neoadjuvant chemoradiation. Staging laparoscopy before initiation of treatment or before surgical resection has improved staging accuracy and can drastically inform treatment decisions. The longstanding and contentious debate on the optimal extent of lymph node dissection for gastric cancer appears to have settled in favor of D2 dissection with the recently published 15-year followup of the Dutch randomized trial. Minimally invasive gastric and gastroesophageal resections are performed routinely in most centers affording faster recovery and equivalent oncologic outcomes. Pylorus-preserving distal (central) gastrectomy has emerged as a less invasive, function-preserving option for T1N0 middlethird gastric cancers, while randomized data on its oncologic adequacy are pending. Multi-visceral resections and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy has been utilized selectively for patients with locally advanced tumors who have demonstrated disease control on preoperative chemotherapy.This review summarizes the current standard of surgical care for gastroesophageal junction and gastric cancer as well as highlights recent and upcoming advances to the field.

Preoperative Prognostic Nutritional Index Predict Survival in Patients with Resectable Adenocarcinoma of the Gastroesophageal Junction: A Retrospective Study Based on Propensity Score Matching Analyses

“…However, there is a significant risk of postoperative recurrence. 12 Although the tumor-node-metastasis (TNM) stage might assess the prognosis of AGE, the TNM classification only considers the extent of the tumor, regardless of its biological characteristics or the host’s anticancer response. It will consequently become more crucial to identify a simple, reliable, and repeatable factor that might accurately predict a patient’s prognosis for AGE.…”

Nomogram predicted overall survival and cancer-specific survival of patients with cardia gastric adenocarcinoma (CGA): A Population- Based Study

“…Finally, in terms of treatment, although the distance of the tumor epicenters from the gastric cardia varies and thus there is no consensus on the best surgical strategy in clinical practice [29] . However, surgery remains the primary treatment for survival bene ts in patients with CGA and can be effective in improving patient survival [8,30] .…”

Analysis of Patient Outcomes following Curative R0 Multiorgan Resections for Locally Advanced Gastric Cancer: A Systematic Review and Meta-Analysis

“…One of the least analyzed types of gastric cancer among the analyzed studies was the LAGC involving the gastroesophageal junction. The study by Narayan et al [43] underscores the shift towards perioperative combination chemotherapy or neoadjuvant chemoradiation for localized disease management, the pivotal role of staging laparoscopy in enhancing staging accuracy, and the consensus favoring D2 lymph node dissection as evidenced by the 15-year follow-up results of the Dutch randomized trial [44]. It was observed that many surgical approaches emerged, such as pylorus-preserving distal gastrectomy for select early-stage gastric cancers and the selective use of multi-visceral resections and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for locally advanced tumors, marking significant strides in the field's ongoing development.…”