Conventional Surgery for Gastric Cancer

Kwon, Sung Joon

Abstract

In Korea, gastric cancer ranks second among all the causes of death from cancer, and is the most frequently diagnosed cancer. Surgery is the only possible curative treatment, and results of gastrectomy have improved throughout the years with respect to survival, morbidity, and postoperative mortality. Extent of gastric resection and type of reconstruction can affect the survival and postoperative quality of life (QOL) in gastric cancer patients. Various kinds of reconstruction, especially after total gastrectomy, has been applied to improve the QOL. Eastern, especially Korean and Japanese, surgeons differ in their approaches to lymph node dissection during surgery for stomach cancer compared to Western surgeons. D2 lymph node dissection has not gained widespread popularity in the West, because improved survival has never been demonstrated in randomized trials. However, Korean surgeons believe that D2 dissection is not a dangerous procedure if done by specialists in specialized centers. It is still a matter of question if chemoradiotherapy after D2 dissection can improve the results of D2 dissection alone. However, the more urgent issue is to establish the standard adjuvant chemotherapy protocol after the good local control by surgery (D2 or more).