Controversies in the Surgical Management of Gastric Cancer

Abstract

Although the incidence of gastric adenocarcinoma in the United States has declined steadily since the early 1900s, it remains a significant health problem. Progress has been made during the past few decades in several areas: Lymph node staging has been refined, perioperative mortality has fallen, and plausible adjuvant therapy has emerged. Currently, complete surgical resection is the mainstay of therapy because it is the only potentially curative option; however, considerable controversy remains regarding the specifics of a surgical approach. This article examines 4 major controversies in the management of gastric cancer: extent of gastric resection, role of extended lymph node dissection, value of elective splenectomy for proximal gastric lesions, and current state of adjuvant therapy. Pertinent retrospective and prospective studies are reviewed to help formulate meaningful conclusions.

Limited Gastric Resection

“…Thus, the goal of any surgery for gastric cancer is the removal of all gross and microscopic disease. Given the propensity for submucosal spread of tumor, proximal margins of 5 to 6 cm, with routine frozen-section analysis, are considered optimal by many authors [5,6].…”