Lymphadenectomy in gastric cancer: Contentious issues

Garg, Pankaj; Jakhetiya, Ashish; Sharma, Jyoti; Ray, M. D.; Pandey, Durgatosh

doi:10.4240/wjgs.v8.i4.294

Cited by 17 publications

(13 citation statements)

References 26 publications

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“…One of them was the fact that surgeons participating in this trial had no previous experience in D2 lymphadenectomies and they were trained using video recurrence rates were also lower in D2 group. The overall 15-year survival was 21% in D1 group and 29% in D2, without statistically significant difference (p = 0.34) [4,9].…”

Section: Extent Of Lymphadenectomy For Stage Ib-iii Gastric Carcinomamentioning

confidence: 84%

“…The third landmark RCT on this subject, the Italian study, found comparable overall morbidity (12.0% in D1 vs. 17.9% in D2, p = 0.178) and no significant difference in 30-day postoperative mortality rate (3.0% in D1 vs. 2.2% in D2, p = 0.72). The essential difference was that only experienced surgeons participated in this trial and that distal pancreatectomy with splenectomy was not routinely performed [4,9]. The main conclusion is that in Western countries D2 lymphadenectomy can be safely performed in high-volume centres by experienced surgeons.…”

Section: Extent Of Lymphadenectomy For Stage Ib-iii Gastric Carcinomamentioning

confidence: 99%

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Surgical Management of Malignant Gastric Tumours: A Practical Guide

Rumba¹,

Vanags²,

Kalva³

et al. 2017

Gastric Cancer

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Gastric cancer is one of the most common gastrointestinal malignancies, known also for its dismal prognosis, except early cases. Despite the advances in systemic therapy, surgery remains the cornerstone of treatment. The majority of gastric cancers are carcinomas, while neuroendocrine tumours and gastrointestinal stromal tumours (GISTs) rank next by frequency. Tumour biology, disease course and prognosis differ amongst the aforementioned gastric cancers; thus, surgical treatment has to be adjusted as well. Accumulation of evidence ensures an individualised approach in all aspects of surgical treatment. Specific criteria are set to choose the best surgical treatment while maintaining postoperative function and acceptable life quality. Minimally invasive techniques continue to gain acceptance, while usage is still highly variable. Endoscopic resection is suitable for very early adenocarcinomas, whereas more advanced tumours require standard gastrectomy. Despite the initial concerns, subtotal gastrectomy (SG) is feasible and safe, especially for distal adenocarcinomas. In recent years, D2 lymphadenectomies have become more frequent in Western countries, and evidence supports this tendency. Surgery for gastric neuroendocrine tumours is type-specific and will be discussed in detail. Gastrointestinal stromal tumours are treated by local resection without wide margins or extensive lymph node dissection. Novel targeted therapy can aid surgical treatment by downstaging larger GISTs.

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Section: Extent Of Lymphadenectomy For Stage Ib-iii Gastric Carcinomamentioning

confidence: 84%

Section: Extent Of Lymphadenectomy For Stage Ib-iii Gastric Carcinomamentioning

confidence: 99%

Surgical Management of Malignant Gastric Tumours: A Practical Guide

Rumba¹,

Vanags²,

Kalva³

et al. 2017

Gastric Cancer

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“…Focusing on the extension of the lymph node dissection, nowadays the D2 lymphadenectomy with preservation of the pancreas and spleen is considered the standard of care by the guidelines of various global scientific societies [ 34 , 35 ] and it is recommended to be conducted by an experienced surgeon, especially if performed laparoscopically [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic versus open distal gastrectomy for locally advanced gastric cancer in middle–low-volume centers in Western countries: a propensity score matching analysis

Garbarino

Costa

Laracca

et al. 2020

Langenbecks Arch Surg

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Background Gastrectomy with D2 lymphadenectomy is the standard treatment for patients with resectable gastric cancer. Laparoscopic distal gastrectomy (LDG) is routinely performed for early gastric cancer, and its indications are increasing even for locally advanced gastric cancer. The aim of this study is to compare two middle-low-volume centers in Western countries experience on LDG versus open distal gastrectomy (ODG) for locally advanced gastric cancer in terms of surgical and oncological outcomes. Methods We reviewed the data of 123 consecutive patients that underwent LDG and ODG with D2 lymphadenectomy between 2009 and 2014. Among them, 91 were eligible for inclusion (46 LDG and 45 ODG). After propensity score matching analysis, using a 1:1 case-control match, 34 patients were stratified for each group. Results The mean operative time was significantly longer in the LDG group (257.2 vs. 197.2, p < 0.001). No differences were observed in terms of intraoperative blood loss, average number of lymph nodes removed, and lymph node metastases. The postoperative morbidity was comparable in the two groups. LDG group had a significant faster bowel canalization and soft oral intake (p < 0.001). The 5-year overall and disease-free survival were higher for patients treated by laparoscopy, but the post-hoc subgroups analysis revealed that the advantage of LDG was significant just in N0 and stage IB-II patients, whereas N+ and stage III patient's survival curves were perfectly superimposable. Conclusions LDG for locally advanced gastric cancer seems to be feasible and safe with surgical and long-term oncological outcomes comparable with open surgery, even in medium-low-volume centers.

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“…Gastric cancer is the fifth most common and third most lethal cancer worldwide, with 783,000 deaths in 2018 [1]. Gastrectomy with regional lymphadenectomy is the preferred surgical treatment for nonmetastatic gastric adenocarcinoma [2]. Despite multimodal treatment, the majority of patients with advanced nonmetastatic cancer recur with the peritoneal disease (29–56%) [3-6].…”

Section: Introductionmentioning

confidence: 99%

Lack of Oncological Benefit from Bursectomy in Radical Gastrectomy: A Systematic Review

Garg¹,

Jakhetiya

Turaga

et al. 2021

Visc Med

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Background: Resection of the omental bursa has been suggested to reduce peritoneal recurrence and facilitate a complete oncological resection during a gastrectomy. The addition of this procedure increases technical complexity and prolongs the procedure. Published data regarding the oncological benefit of this procedure are conflicting. We hypothesized that a bursectomy during a radical gastrectomy does not improve overall survival. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline, a comprehensive literature search of 3 electronic databases (PubMed, Scopus, and Embase) was conducted to identify the clinical studies that compared bursectomy with no-bursectomy in radical gastrectomy for gastric adenocarcinoma. Qualitative and quantitative data synthesis was performed using RevMan software. A random-/fixed-effect modeling was used depending upon the heterogeneity. Bias and quality assessment tools were applied. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42019116556). Results: Of 8 studies assessing the role of bursectomy in gastric adenocarcinoma, 6 (75%) were included – of which 2 (33%) are randomized controlled trials. Of 2,904 patients, 1,273 (%) underwent a bursectomy. There was no statistically significant difference in either overall survival (hazard ratio [HR] = 0.89, 95% CI 0.75–1.06, I2 = 14%) or disease recurrence (HR = 1.01, 95% CI 0.84–1.20, I2 = 22%) in the bursectomy group compared to the no-bursectomy group. Conclusion: There is no additional oncological benefit of adding bursectomy to radical gastrectomy in all patients with gastric adenocarcinoma.

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Lymphadenectomy in gastric cancer: Contentious issues

Cited by 17 publications

References 26 publications

Surgical Management of Malignant Gastric Tumours: A Practical Guide

Surgical Management of Malignant Gastric Tumours: A Practical Guide

Laparoscopic versus open distal gastrectomy for locally advanced gastric cancer in middle–low-volume centers in Western countries: a propensity score matching analysis

Lack of Oncological Benefit from Bursectomy in Radical Gastrectomy: A Systematic Review

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