Changing Trends in Gastric Cancer Surgery

Abstract

Gastric cancer is one of the most common causes of cancer-related death. It requires multimodal treatment and surgery is the most effective treatment modality. Radical surgery includes total or subtotal gastrectomy with lymph node dissection. The extent of lymphadenectomy still remains controversial. Eastern surgeons have performed D2 or more extended lymphadenectomy while their Western colleagues have performed more limited lymph node dissection. However, the trend has been changing in favour of D2 lymph node dissection in both hemispheres. Currently, D2 is the recommended type of lymphadenectomy in experienced centres in the west. In Japan, D2 lymph node dissection is the standard surgical approach. More extensive lymphadenectomy than D2 has not been found to be associated with improved survival and generally is not performed. Bursectomy and splenectomy are additional controversial issues in surgical performance, and trends regarding them will be discussed. The performance of bursectomy is controversial and there is no clear evidence of its clinical benefit. However, a trend toward better survival in patients with serosal invasion has been reported. Routine splenectomy as a part of lymph node dissection has largely been abandoned, although splenectomy is recommended in selected cases. Minimally invasive surgery has gained wide popularity and indications for minimally invasive procedures have been expanding due to increasing experience and improving technology. Neoadjuvant therapy has been shown to have beneficial effects and seems necessary to provide a survival benefit. Diagnostic laparoscopy should be kept in mind prior to treatment.

Safety and feasibility of laparoscopic gastrectomy accompanied by D1+ lymph node dissection for early gastric cancer in elderly patients

“…This raised a simple question: Is aggressive LN dissection necessary in elderly patients? The impact of LG or LN dissection on the outcome of gastric cancer has been previously discussed (25,26). Our long-term outcomes demonstrated no significant differences in either OS or RFS between the two groups.…”

Decreasing mortality and hospitalizations with rising costs related to gastric cancer in the USA: an epidemiological perspective

“…We also found a decline in gastric cancer-related inpatient mortalities during the study period, which can be related to the improved management of gastric cancers and overall improved survival with the advent of more sophisticated surgical techniques and use of preoperative chemotherapies [ 43 ]. Furthermore, the implementation of hospice care for patients with advanced disease unamenable to aggressive therapy has decreased the rate of inpatient hospitalizations and overall inpatient deaths [ 44 ].…”

Pooled analysis of the oncological outcomes in robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer

“…Now, robotic surgical systems overcome LG limitations by providing a three-dimensional magnified view, more comfortable surgeon position, ergonomic comfort and elimination of physiologic tremor. [ 6 10 ] Since the first robot-assisted distal gastrectomy was performed by Giulianotti et al . in 2003,[ 11 ] more and more studies have shown that RG is a safe and feasible method for the treatment of gastric cancer.…”