Changing Trends in Gastric Cancer Surgery

Ozer I., Bostanci E. B., Ulas M., Ozogul Y., Akoglu M.

BALKAN MEDICAL JOURNAL, cilt.34, sa.1, ss.10-20, 2017 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Derleme
  • Cilt numarası: 34 Sayı: 1
  • Basım Tarihi: 2017
  • Doi Numarası: 10.4274/balkanmedj.2015.1461
  • Dergi Adı: BALKAN MEDICAL JOURNAL
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, TR DİZİN (ULAKBİM)
  • Sayfa Sayıları: ss.10-20
  • Anahtar Kelimeler: Gastric cancer, lymph node dissection, bursectomy, splenectomy, minimally invasive surgery, LYMPH-NODE DISSECTION, LAPAROSCOPIC TOTAL GASTRECTOMY, RANDOMIZED CLINICAL-TRIAL, NEOADJUVANT CHEMOTHERAPY, GASTROESOPHAGEAL ADENOCARCINOMA, PERIOPERATIVE CHEMOTHERAPY, DISTAL GASTRECTOMY, D-2 RESECTIONS, BURSECTOMY, D2
  • Eskişehir Osmangazi Üniversitesi Adresli: Evet

Özet

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.