Korean Practice Guidelines for Gastric Cancer 2022: An Evidence-based, Multidisciplinary Approach

Abstract

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.

Changes in failure to rescue after gastrectomy at a large-volume center with a 16-year experience in Korea

“…Depending on the location and clinical stage of the lesion, subtotal gastrectomy, total gastrectomy, or proximal gastrectomy was conducted. According to the Korean Practice Guideline for Gastric Cancer, D1 + lymphadenectomy was performed for early gastric cancer patients with any suspicion of LN metastasis, and D2 lymphadenectomy was performed for patients with suspicion of LN metastasis or advanced gastric cancer 14 . The exclusion criteria were preoperative palliative-aimed chemotherapy or radiation therapy for current gastric cancer, M1 patients, R1 or R2 resection, and incomplete information on clinical or pathological features.…”

Mediastinal Lymph Node Dissection in Gastroesophageal Junction Adenocarcinoma

“…A systematic lower mediastinal node dissection is proposed for GEJAC with a length of esophageal involvement of 2–4 cm. Proximal gastrectomy with resection of the distal esophagus seems more suitable for this tumor when it is resectable, and a laparoscopic transhiatal approach is preferable to an open or transthoracic approach in GEJAC surgery [ 30 ]. Further randomized controlled studies are required to confirm this hypothesis.…”

Role of Adjuvant Radiotherapy in Gastric Cancer

“…A previous meta-analysis of six randomized trials with similar designs was performed to compare the efficacy of adjuvant CRT with that of adjuvant chemotherapy alone in patients with complete D2-resected GC [ 11 12 14 28 41 42 43 44 45 46 ], including the abovementioned two recent studies, based on the results of a systematic review conducted according to the new version of the Korean Practice Guidelines for Gastric Cancer [ 47 ]. The overall detailed process and progress of the systematic review and meta-analysis of these guidelines will be published in another article; moreover, the full supporting data addressing the key question, “Could adjuvant concurrent chemoradiation improve the treatment outcomes compared with adjuvant chemotherapy alone in patients with pathological stage II or III who underwent curative gastrectomy with D2 lymph node dissection?”, which is consistent with the topic discussed in this review, will be published separately in this journal [ 47 ]. A summary of the six randomized controlled trials evaluating the efficacy of adjuvant CRT in addition to adjuvant chemotherapy in patients with completely D2-resected GC included in this meta-analysis is presented in Table 2 .…”