Extended gastrectomy: Who benefits?

Abstract

In the area of radical surgical treatment of gastric carcinoma, extended or multiorgan resection is--as is systematically extended lymph node dissection--becoming increasingly important. One indication for extended gastrectomy is intramural or transmural infiltration of neighboring organs or the gross presence of metastatic involvement of the lymph nodes associated with the celiac trunk, splenic artery, or splenic hilum. Because the mortality rate associated with extended gastrectomy is hardly any higher than that for nonextended gastrectomy, the indication for the former may be generously applied. The prognostically most unfavorable case is histologic evidence of transmural infiltration of neighboring organs (pT4). Multiorgan resection with improved systematic extension of lymph node dissection is of greatest benefit to patients with inflammatory adhesion of the stomach to neighboring organs or pN2 lymph node metastases. Intramural infiltration of the esophagus can be treated by including the thoracic part of the esophagus in the gastric resection done via an abdominothoracic approach, ensuring an appropriate margin of clearance, with no significant worsening of the prognosis.

Postoperative Quality of Life after Total Gastrectomy Compared with Partial Gastrectomy: Longitudinal Evaluation by European Organization for Research and Treatment of Cancer-OG25 and STO22

“…Therefore, quality of life (QOL) after gastrectomy has become increasingly important. When evaluating treatments for cancer, health-related QOL has been acknowledged as an important outcome in addition to oncologic outcomes and safety issues 6789…”

Ecoendoscopia na avaliação pré-operatória do estádio em doentes com câncer gástrico: correlação com os achados cirúrgicos e/ou histopatológicos

“…A precisão para todas as categorias foram elevadas, demonstrando a forte correlação entre os dois métodos diagnósticos. Na interpretação dos casos discordantes, é importante lembrar que o falso-positivo pode decorrer de aderências inflamatórias peritumorais (26,51) e o falso-negativo de infiltrações de vísceras ocas, especialmente o intestino grosso (43) . Ecoendoscopia T1 T2 T3 T4 Total T1 3 1 1 5 T2 2 2 T3 6 3 9 T4 14 14 Total 3 3 6 18 30 TABELA 2.…”

Sobrevida a 5 años en relación al tipo histológico de cáncer de estómago.

“…En la actualidad se considera el estadío tumoral (35), a las metástasis ganglionar linfática (36) y a la profundidad de invasión tumoral (37) como los principales factores pronósticos después que se intenta una resección para cáncer gástrico. Boku et al (38) también encuentran que a mayor agregado total de invasión serosa y metástasis ganglionar linfática, menor la sobrevida a 5 años.…”