Surgical Treatment of Advanced Gastric Cancer

Abstract

Patients with advanced gastric cancer generally have poor overall prognosis as well as survival rate. Unfortunately, in the West, gastric cancer typically occurs at an advanced stage and many of these patients have tumor invasion into adjacent structures (International Union Against Cancer [UICC]/American Joint Committee on Cancer [AJCC] Stage T4). Although T4 gastric cancer patients often have peritoneal dissemination or distant metastasis, many do not have M1 disease and are therefore candidates for surgery with the curative intent. A multivisceral resection (MVR) or gastrectomy with resection of adjacent organs is needed in T4 gastric cancer patients to achieve an R0 resection that is one of the most powerful forecasters of gastric cancer surgery results. Spleen, distal pancreas, liver, and large intestine (mostly transverse colon) were the most commonly resected organs. The therapeutic choice with acceptable postoperative morbidity and mortality rates in locally advanced patients with gastric cancer should be gastrectomy with MVR, where complete resection could be realistically obtained and where metastatic involvement of the lymph node is not evident. MVR is done with a curative R0 resection to provide advanced gastric cancer patients with the best survival chance. It was found that resections involving the pancreas, transverse colon and liver were associated with increased survival rate in comparison to MVR with resection of other structures. It was shown that survival rate significantly decreased in patients who had undergone MVR without complete resection compared to those who had an R0 resection. Nevertheless, the extent of the surgical resection required and further advantages of MVR are disputable.