Gastric Cancer Surgery. How Significant is the Progress?

Abstract

In 1971 Richard Nixon declared war on cancer. It's interesting to note that military terms are often used in oncology: treatments are "aggressive", there are therapeutic "strategies", receptor's "blockade", or "treatment lines" and chemotherapy drugs "attack" cancer. Well, Nixon's commitment to "defeating cancer" could not be honored. Moreover, still using military terms, we have to quote journalist Sharon Begley: "We fought cancer ... and cancer won" (1). Is her skepticism exaggerated? What is the actual situation in the field of gastric adenocarcinoma treatment, an area where enormous amounts of money have been invested, great progress has been made in understanding tumor biology, and crucial therapeutic successes are claimed, like chemotherapy, minimally invasive surgery, lymphadenectomy and many others? Are they just illusions, forms of marketing,or have they really brought a benefit in survival rates and quality of life for real patients, not just for those in clinical trials? Obviously, D2 lymphadenectomy, following the Japanese model (with some nuances regarding the preservation of spleen and pancreatic tail), was internationally adopted. After a period of hesitation, due mostly to European studies showing a higher rate of complications for D2 lymphadenectomy-albeit with some design problems,this surgical technique started being considered safe worldwide in 2006 (2). D2 lymphadenectomy is widely used in surgical practice in Romania as well (3-5). There is no consensus on the minimum number of nodes to be dissected: 15, 20, 29 or more than 30 (6)? But we already know that it is preferable for an accurate assessment, to dissect the lymph nodes "ex vivo", on the fresh resection specimen, immediately after surgery (7). Generally speaking, we agree with the Japanese authors: "Dissect as many lymph nodes as possible and you will be rewarded" (8).

Splenic Cysts: A Strong Indication for a Minimally Invasive Partial Splenectomy. Could the Splenic Hilar Vasculature Type Hold a Defining Role?

“…The laparoscopic technique offers a surgical success similar to the conventional open surgery, but with the advantages of minimally invasive procedures. However, sometimes laparoscopic partial splenectomy is challenging, and for these particular cases the robotic approach can overcome the potential difficulties by improving vision and motion control [9, 10].…”