Korean J Gastroenterol.  2011 Jun;57(6):335-339. 10.4166/kjg.2011.57.6.335.

Individualized Surgery for Gastric Cancer

• Seo KW
• Yoon KY

• KMID: 1792796
• DOI: http://doi.org/10.4166/kjg.2011.57.6.335

Abstract

Recently, tailored and multidisciplinary treatment of gastric cancer was emerging in the field of clinical oncology. Gastric cancer is the most frequently diagnosed cancer in Korea. Surgery is the only possible curative procedure, and extensive gastrectomy and D2 lymph node dissection has been accepted as standard treatment in all gastric cancer patients until recently. In early gastric cancer, many researchers established the indications of limited surgery including endoscopic mucosal resection based on various well-collected retrospective data. Limited surgery and minimally invasive surgery contribute to quality of life in gastric cancer patients. In advanced gastric cancer, eastern surgeons believe that D2 lymph node dissection is standard treatment if done by credential surgeons in specialized centers despite of different opinion of western surgeon. In addition, adjuvant chemotherapy after good local control by D2 dissection has gained survival benefit rather than D2 dissection alone in randomized trials. In conclusion, present confronted issue is to establish tailored treatments of individualized patients through extent of disease in gastric cancer patients.

Keyword

Gastric neoplasm; Gastrectomy; Lymph node dissection; Tailored treatment

Reference

References

1. National Cancer Information Center. Cancer incidence and death rate in Korea. http://www.cancer.go.kr/cms/index.html. 2011.

2. Wang J, Yu JC, Kang WM, Ma ZQ. Treatment strategy for early gastric cancer. Surg Oncol. 2011. [Epub ahead of print].

3. Koeda K, Nishizuka S, Wakabayashi G. Minimally invasive surgery for gastric cancer: the future standard of care. World J Surg. 2011. [Epub ahead of print].

4. McNeer G, Sunderland DA, McInnes G, Vandenberg HJ Jr, Lawrence W Jr. A more thorough operation for gastric cancer; anatomical basis and description of technique. Cancer. 1951; 4:957–967.

5. Kajitani T. The general rules for the gastric cancer study in surgery and pathology. Part I. Clinical classification. Jpn J Surg. 1981; 11:127–139.

6. Maruyama K, Gunvén P, Okabayashi K, Sasako M, Kinoshita T. Lymph node metastases of gastric cancer. General pattern in 1931 patients. Ann Surg. 1989; 210:596–602.

7. Kodama Y, Sugimachi K, Soejima K, Matsusaka T, Inokuchi K. Evaluation of extensive lymph node dissection for carcinoma of the stomach. World J Surg. 1981; 5:241–248.

8. Otsuji E, Toma A, Kobayashi S, Okamoto K, Hagiwara A, Yamagishi H. Outcome of prophylactic radical lymphadenectomy with gastrectomy in patients with early gastric carcinoma without lymph node metastasis. Cancer. 2000; 89:1425–1430.

9. Kwon SJ. Conventional surgery for gastric cancer. Korean J Gastroenterol. 2005; 45:17–22.

10. Gotoda T, Yanagisawa A, Sasako M, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000; 3:219–225.

11. Nakajima T. Gastric cancer treatment guidelines in Japan. Gastric Cancer. 2002; 5:1–5.

12. Yamao T, Shirao K, Ono H, et al. Risk factors for lymph node metastasis from intramucosal gastric carcinoma. Cancer. 1996; 77:602–606.

13. Kitano S, Shiraishi N, Kakisako K, Yasuda K, Inomata M, Adachi Y. Laparoscopy-assisted Billroth-I gastrectomy (LADG) for cancer: our 10 years' experience. Surg Laparosc Endosc Percutan Tech. 2002; 12:204–207.

14. Lee JH, Yom CK, Han HS. Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer. Surg Endosc. 2009; 23:1759–1763.

15. Kim HH, Hyung WJ, Cho GS, et al. Morbidity and mortality of lapa-roscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report–a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg. 2010; 251:417–420.

16. Kong SH, Kim JW, Lee HJ, Kim WH, Lee KU, Yang HK. The safety of the dissection of lymph node stations 5 and 6 in pylorus-pre-serving gastrectomy. Ann Surg Oncol. 2009; 16:3252–3258.

17. Nunobe S, Kiyokawa T, Hatao F, et al. Triangulating stapling technique for anastomosis in laparoscopy-assisted pylorus-preserving gastrectomy. Dig Surg. 2010; 27:359–363.

18. Jiang X, Hiki N, Nunobe S, et al. Long-term outcome and survival with laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer. Surg Endosc. 2011; 25:1182–1186.

19. Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet. 1996; 347:995–999.

20. Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lymph- node dissection for gastric cancer. N Engl J Med. 1999; 340:908–914.

21. Cuschieri A, Weeden S, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Cooperative Group. Br J Cancer. 1999; 79:1522–1530.

22. Wu CW, Hsiung CA, Lo SS, et al. Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol. 2006; 7:309–315.

23. Takashima S, Kosaka T. Results and controversial issues regarding a para-aortic lymph node dissection for advanced gastric cancer. Surg Today. 2005; 35:425–431.

24. Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008; 359:453–462.

25. Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006; 355:11–20.

26. Sakuramoto S, Sasako M, Yamaguchi T, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007; 357:1810–1820.