Gastric cancer—surgical approach

Abstract

Although the incidence of carcinoma of the stomach has steadily declined over the last 50 years, approximately 23,000 new cases will be diagnosed in the United States this year and 13,700 patients will die. Despite marked improvement in operative techniques, fewer than 20 per cent of those diagnosed with gastric cancer beyond the most superficial levels of invasion will survive for over five years. Gastric tumours spread by local, lymphatic, and aggressive intra-peritoneal routes as well as hematogenous dissemination. Over 87 per cent of recurrences have local or regional components. Radiation therapy may decrease local and regional recurrences in those patients with transmural tumours. The neoadjuvant use of etoposide, adriamycin, and platinum may yield complete clinical and pathologic responses in patients found to have 'unresectable' tumours. Other chemotherapy regimens have been shown to have some effect on advanced disease and may have a role in the neoadjuvant setting. Our current recommendations for the treatment of gastric cancer in a controlled trial setting would be neoadjuvant chemotherapy followed by R2 resection, postoperative +/- intraoperative radiation therapy with the possibility of postoperative chemotherapy. Hopefully, this aggressive multimodality approach will significantly improve the five year survival for this disease.

Indications for endo-organ gastric excision

“…Despite a decreasing incidence, gastric cancer remains a serious problem in the United States, causing 13,700 deaths annually, primarily because most gastric cancers are discovered at an advanced stage [6,57]. Approximately 36% and 31% are discovered as stages III and IV lesions, respectively.…”

Systemic Chemotherapy in Gastric Cancer: Where Do We Stand Today?

“…Nevertheless, two prospective randomized studies outside Japan [10,11] failed to reproduce these results. In spite of the undoubted improvement in the surgical management of gastric cancer, still more than 50% of patients undergoing curative resection will relapse and eventually die of their disease, with local and regional recurrence being the most frequent pattern of failure [12].…”

Adjuvant chemotherapy for oesophagogastric cancer with epirubicin, cisplatin and infusional 5-fluorouracil (ECF): a Royal Marsden pilot study

“…Surgery alone is the treatment of choice for tumours confined to the mucosa and submucosa, achieving cure rates of more than 80% (Thompson and Van Heerden, 1993). When disease is locally advanced (T3/T4) curative surgery is possible in only a minority of patients (Rahamin and Cham, 1993;McCulloch, 1994) and disease recurrence after potentially curative resection in locally advanced gastric cancer occurs in approximately 80% of the patients within 5 years of surgery (Girling, 1992;Weese and Nussbaum, 1992).…”