J Gastric Cancer.  2011 Mar;11(1):1-6.

Recent Evolution of Surgical Treatment for Gastric Cancer in Korea

• An JY
• Cheong JH
• Hyung WJ
• Noh SH

Abstract

Gastric cancer is the most common malignancy and the incidence is steadily increasing in Korea. The principal treatment modality for gastric cancer is surgical extirpation of tumor along with draining lymph nodes. Gastrectomy with D2 lymph node dissection has been well established as a standard of surgery and improved the survival of gastric cancer patients. Recently, technological advances are drastically reshaping the landscape of surgical treatment of gastric cancer. One of the most notable trends is that minimal access surgery becomes dominating the treatment of early stage diseases. For advanced diseases, the standard access surgery is considered a reference treatment. Although there is a pilot study underway to evaluate the feasibility of the application of minimal access surgery to advanced gastric cancer (AGC), the evidence for oncological safety is not yet provided sufficiently. Based on the recent randomized controlled trials, the extent of surgery for AGC has re-defined as para-aortic lymph node dissection dose not add any survival benefit while increasing surgery-related morbidities. In addition, it is now accepted as a standard operation omitting unnecessary procedures such as splenectomy and/or distal pancreatectomy for prophylactic lymph node dissection. Conceptual and technical innovation has contributed to decreasing morbidity and mortality without impairing oncological safety. All these recent advances in the field of gastric cancer surgery would be concluded in maximizing therapeutic index for gastric cancer while improving quality of life.

Keyword

Stomach neoplasms; Therapeutics; Korea; General surgery

MeSH Terms

Gastrectomy
Humans
Incidence
Korea
Lymph Node Excision
Lymph Nodes
Pancreatectomy
Quality of Life
Splenectomy
Stomach Neoplasms
Unnecessary Procedures

Reference

1. Jung KW, Park S, Kong HJ, Won YJ, Boo YK, Shin HR, et al. Cancer statistics in Korea: incidence, mortality and survival in 2006-2007. J Korean Med Sci. 2010. 25:1113–1121.

2. Accessed February 27, 2011. http://www.cancer.go.kr/cms/statics/.

3. The Information Committee of the Korean Gastric Cancer Association. 2004 Nationwide gastric cancer report in Korea. J Korean Gastric Cancer Assoc. 2007. 7:47–54.

4. Sim YK, Kim CY, Jeong YJ, Kim JH, Hwang Y, Yang DH. Changes of the clinicopathological characteristics and survival rates of gastric cancer with gastrectomy: 1990s vs early 2000s. J Korean Gastric Cancer Assoc. 2009. 9:200–206.

5. Sano T, Sasako M, Yamamoto S, Nashimoto A, Kurita A, Hiratsuka M, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy--Japan Clinical Oncology Group study 9501. J Clin Oncol. 2004. 22:2767–2773.

6. Park DJ, Lee HJ, Kim HH, Yang HK, Lee KU, Choe KJ. Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg. 2005. 92:1099–1102.

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

8. Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995. 345:745–748.

9. Chung IK, Lee JH, Lee SH, Kim SJ, Cho JY, Cho WY, et al. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc. 2009. 69:1228–1235.

10. Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, 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. Park YD, Chung YJ, Chung HY, Yu W, Bae HI, Jeon SW, et al. Factors related to lymph node metastasis and the feasibility of endoscopic mucosal resection for treating poorly differentiated adenocarcinoma of the stomach. Endoscopy. 2008. 40:7–10.

12. Kim JH, Lee YC, Kim H, Song KH, Lee SK, Cheon JH, et al. Endoscopic resection for undifferentiated early gastric cancer. Gastrointest Endosc. 2009. 69:e1–e9.

13. An JY, Baik YH, Choi MG, Noh JH, Sohn TS, Kim S. Predictive factors for lymph node metastasis in early gastric cancer with submucosal invasion: analysis of a single institutional experience. Ann Surg. 2007. 246:749–753.

14. Kim MC, Kim W, Kim HH, Ryu SW, Ryu SY, Song KY, et al. Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group. Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale korean multicenter study. Ann Surg Oncol. 2008. 15:2692–2700.

15. Song J, Lee HJ, Cho GS, Han SU, Kim MC, Ryu SW, et al. Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group. Recurrence following laparoscopy-assisted gastrectomy for gastric cancer: a multicenter retrospective analysis of 1,417 patients. Ann Surg Oncol. 2010. 17:1777–1786.

16. Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, et al. Morbidity and mortality of laparoscopic 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.

17. Song J, Kang WH, Oh SJ, Hyung WJ, Choi SH, Noh SH. Role of robotic gastrectomy using da Vinci system compared with laparoscopic gastrectomy: initial experience of 20 consecutive cases. Surg Endosc. 2009. 23:1204–1211.

18. Park do J, Lee HJ, Jung HC, Kim WH, Lee KU, Yang HK. Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis. World J Surg. 2008. 32:1029–1036.

19. An JY, Youn HG, Choi MG, Noh JH, Sohn TS, Kim S. The difficult choice between total and proximal gastrectomy in proximal early gastric cancer. Am J Surg. 2008. 196:587–591.

20. Kong SH, Kim JW, Lee HJ, Kim WH, Lee KU, Yang HK. Reverse double-stapling end-to-end esophagogastrostomy in proximal gastrectomy. Dig Surg. 2010. 27:170–174.

21. Kitagawa Y, Fujii H, Kumai K, Kubota T, Otani Y, Saikawa Y, et al. Recent advances in sentinel node navigation for gastric cancer: a paradigm shift of surgical management. J Surg Oncol. 2005. 90:147–151.

22. Lee JH, Hyung WJ, Noh SH. Comparison of gastric cancer surgery with versus without nasogastric decompression. Yonsei Med J. 2002. 43:451–456.

23. Kim J, Lee J, Hyung WJ, Cheong JH, Chen J, Choi SH, et al. Gastric cancer surgery without drains: a prospective randomized trial. J Gastrointest Surg. 2004. 8:727–732.

24. Japanese Gastric Cancer Association. Japanese Classification of Gastric Carcinoma - 2nd English Edition -. Gastric Cancer. 1998. 1:10–24.

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

26. Schwarz RE, Smith DD. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol. 2005. 23:5404–5405.

27. Lee J, Kim W. Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: analysis of consecutive 106 experiences. J Surg Oncol. 2009. 100:693–698.

28. Hur H, Jeon HM, Kim W. Laparoscopy-assisted distal gastrectomy with D2 lymphadenectomy for T2b advanced gastric cancers: three years' experience. J Surg Oncol. 2008. 98:515–519.

29. Lee KY, Noh SH, Hyung WJ, Lee JH, Lah KH, Choi SH, et al. Impact of splenectomy for lymph node dissection on long-term surgical outcome in gastric cancer. Ann Surg Oncol. 2001. 8:402–406.

30. Oh SJ, Hyung WJ, Li C, Song J, Kang W, Rha SY, et al. Yonsei Gastric Cancer Clinic. The effect of spleen-preserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancer. J Surg Oncol. 2009. 99:275–280.

31. Yu W, Choi GS, Chung HY. Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer. Br J Surg. 2006. 93:559–563.

32. Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, et al. Japan Clinical Oncology Group. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008. 359:453–462.

33. Yonemura Y, Wu CC, Fukushima N, Honda I, Bandou E, Kawamura T, et al. East Asia Surgical Oncology Group. Operative morbidity and mortality after D2 and D4 extended dissection for advanced gastric cancer: a prospective randomized trial conducted by Asian surgeons. Hepatogastroenterology. 2006. 53:389–394.

34. Yonemura Y, Wu CC, Fukushima N, Honda I, Bandou E, Kawamura T, et al. East Asia Surgical Oncology Group. Randomized clinical trial of D2 and extended paraaortic lymphadenectomy in patients with gastric cancer. Int J Clin Oncol. 2008. 13:132–137.

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

36. Masuda TA, Sakaguchi Y, Toh Y, Aoki Y, Harimoto N, Taomoto J, et al. Clinical characteristics of gastric cancer with metastasis to the lymph node along the superior mesenteric vein (14v). Dig Surg. 2008. 25:351–358.

37. Lim JT, Yook JH, Jung O, Kim JH, Oh ST, Kim BS, et al. Indication of dissection of the 14v lymph node in advanced distal gastric cancer. J Korean Gastric Cancer Assoc. 2006. 6:154–160.