Prophylactic bursectomy at radical gastrectomy for gastric cancer

Kayaalp, Cüneyt; Olmez, Aydemir; Pişkin, Turgut

doi:10.1007/s10120-011-0084-7

Cited by 5 publications

(1 citation statement)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, surgeons have also explored more extensive surgeries aiming to eliminate any possible lymphatic spread by applying extended lymphadenectomy, such as superextended (D3) lymphadenectomy (6)(7)(8)(9)(10)(11)(12) or standardized extended (D2) lymphadenectomy plus para-aortic nodal dissection (PAND) (13)(14)(15)(16)(17), together with combined resection, such as prophylactic splenectomy (18)(19)(20)(21)(22)(23)(24) or bursectomy (25)(26)(27)(28)(29)(30). Radical gastrectomy with D2 dissection has been the standard procedure for locally advanced gastric cancer (AGC) in Japan since 1961 (5,(31)(32)(33)(34)(35)(36).…”

Section: Introductionmentioning

confidence: 99%

Gastric cancer surgery: historical background and perspective in Western countries versus Japan

2019

View full text Add to dashboard Cite

Gastrectomy plus D2 lymphadenectomy plays a decisive role in the management of resectable gastric cancer in Japan. Before recent advances in chemotherapy, Japanese surgeons considered that extensive surgery involving extended lymphadenectomy with combined resection of neighboring organ(s) was required to eliminate any possible lymphatic cancer spread and improve patient survival. This approach differs radically from that in Western countries, which aim to improve survival outcomes by multidisciplinary approaches including perioperative chemotherapy and/or radiotherapy with limited lymph node dissection.However, a randomized controlled trial conducted in Japan found that more extensive lymphadenectomy including the para-aortic lymph nodes provided no survival benefit over D2 lymphadenectomy. Splenic hilum dissection with splenectomy also failed to show superiority over the procedure without splenectomy in patients with proximal gastric cancer, except in cases with tumor invasion of the greater curvature. Furthermore, bursectomy recently demonstrated similar outcomes to omentectomy alone. Although "D2 lymphadenectomy" as carried out in Japan contributes to low local recurrence rates and good survival outcomes, the results of randomized controlled trials have led to a decreased extent of surgical resection, with no apparent adverse effects on survival outcome. Notably, gastrectomy with D2 dissection has tended to become acceptable for advanced gastric cancer in Western countries, based on the latest results of the Dutch D1D2 trial. Differences in surgical practices between the West and Japan have thus lessened and procedures are becoming more standardized. Japanese D2 lymphadenectomy for advanced gastric cancer is evolving toward more minimally invasive approaches, while consistently striving to achieve the optimal surgical extent, thereby promoting consensus with Western counterparts.

show abstract

Section: Introductionmentioning

confidence: 99%

Gastric cancer surgery: historical background and perspective in Western countries versus Japan

2019

View full text Add to dashboard Cite

show abstract

Making omental bursectomy, a routine in extended gastrectomy; a step-by-step guide

Blouhos

Hatzigeorgiadis

2013

Hellenic J Surg

View full text Add to dashboard Cite

Bursectomy in gastric cancer surgery: surgical technique and operative safety

Blouhos

Hatzigeorgiadis

2013

Updates Surg

View full text Add to dashboard Cite

Although there is little evidence that bursectomy has clinical benefit, its continuing practice imposes evaluation of bursectomy-related adverse effects, especially pancreatic fistula and intestinal obstruction. The aims of this study were to provide a detailed description of the technique of bursectomy as standardized by the authors and determine if extended surgery for gastric cancer with additional bursectomy can be performed safely in Western population. A total of 72 consecutive patients of median age 76.4 years and mean ASA score grade 2.1, who submitted to D2 or D2+ gastrectomy with additional bursectomy for gastric adenocarcinoma, were prospectively studied. Bursectomy was associated with a median additional operative time of 41 min and a median additional blood loss of 65 ml. The post-operative morbidity rate was 19.4 %. Among various adverse events, pancreatic fistula was observed in three patients (4.2 %) and intestinal obstruction was observed in eight patients (11.1 %) including two cases of delayed gastric emptying, one case of afferent loop syndrome, one case of early postoperative adhesions and four cases of prolonged postoperative ileus. The in-hospital mortality rate was 1.4 %. D2 or D2+ gastrectomy with additional bursectomy can be safely performed in Western patients. Although the incidence of pancreatic fistula that we reported was low, the incidence of bursectomy-related intestinal obstruction was high and should always be kept in mind when performing extended surgery for gastric cancer.

show abstract

Prophylactic bursectomy at radical gastrectomy for gastric cancer

Cited by 5 publications

References 3 publications

Gastric cancer surgery: historical background and perspective in Western countries versus Japan

Gastric cancer surgery: historical background and perspective in Western countries versus Japan

Making omental bursectomy, a routine in extended gastrectomy; a step-by-step guide

Bursectomy in gastric cancer surgery: surgical technique and operative safety

Contact Info

Product

Resources

About