Changing Trends in Gastric Cancer Surgery

Year 2017, Volume: 34 Issue: 1, 10 - 20, 01.01.2017

İlter Özer Erdal Birol Bostancı Murat Ulaş Yusuf Özoğul Musa Akoğlu

Abstract

Gastric cancer is one of the most common causes
of cancer-related death. It requires multimodal
treatment and surgery is the most effective treatment
modality. Radical surgery includes total or subtotal
gastrectomy with lymph node dissection. The extent
of lymphadenectomy still remains controversial.
Eastern surgeons have performed D2 or more extended
lymphadenectomy while their Western colleagues
have performed more limited lymph node dissection.
However, the trend has been changing in favour of D2
lymph node dissection in both hemispheres. Currently,
D2 is the recommended type of lymphadenectomy in
experienced centres in the west. In Japan, D2 lymph
node dissection is the standard surgical approach. More
extensive lymphadenectomy than D2 has not been found
to be associated with improved survival and generally
is not performed. Bursectomy and splenectomy are
additional controversial issues in surgical performance,
and trends regarding them will be discussed. The
performance of bursectomy is controversial and there is
no clear evidence of its clinical benefit. However, a trend
toward better survival in patients with serosal invasion
has been reported. Routine splenectomy as a part of
lymph node dissection has largely been abandoned,
although splenectomy is recommended in selected cases.
Minimally invasive surgery has gained wide popularity
and indications for minimally invasive procedures
have been expanding due to increasing experience and
improving technology. Neoadjuvant therapy has been
shown to have beneficial effects and seems necessary
to provide a survival benefit. Diagnostic laparoscopy
should be kept in mind prior to treatment.

Keywords

Gastric cancer , lymph node dissection , bursectomy , splenectomy , minimally invasive surgery

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