Surgical Strategies for the Treatment of Gastric Cancer Considering Intraoperative Radiation Therapy

Abstract

For gastric carcinomas the surgical strategy is mainly based on tumor site, tumor stage and the Lauren classification. Total gastrectomy and distal resection are adequate procedures, if they are combined with lymphadenectomy of compartments I and II. The necessity for splenectomy depends on the involvement of lymph nodes at the splenic hilum, which is largely determined by the depth of tumor invasion as well as the tumor site. For early gastric cancer restricted to the mucosa of the intestinal cell type, limited treatment may be sufficient. The majority of patients with advanced gastric cancer die of local recurrence and peritoneal spread. Therefore, intraoperative radiation therapy has been employed as adjuvant locoregional therapy. By now a reduction in the local recurrence rate could be confirmed, but a survival benefit remains to be determined.