Results of gastric resection for carcinoma of the stomach: The European experience

Abstract

A European state of the art in the treatment of gastric cancer is presented from the results of a questionnaire. Data were obtained from 62 centers, 60% of which were from abroad and 40% of which were from Germany, reporting a total of 16,594 patients. A feature was a low portion (8.8%) of early cancer. The operation preferred was total gastrectomy. Only in the case of antral carcinoma of the intestinal type, according to Laurén, would the majority perform subtotal gastrectomy. Staging of lymph nodes was performed by 84% of these centers; however, systematic radical dissection was carried out only by 27%. The preferred type of reconstruction after total gastrectomy was Roux‐en‐Y esophagojejunostomy; 16% of the European centers used some type of pouch in addition. Splenectomy was carried out depending on location of the tumor. The median in‐hospital mortality for early cancer was 0; for carcinoma of the antrum, 6.7%; corpus, 9.6%; and gastroesophageal junction, 11.7%. The median 5‐year survival rate in patients with early cancer was 82.5%; for advanced cancer of the antrum, 30.7%; corpus, 24%; and gastroesophageal junction, 15.5%. Ten‐year survival was 6–10% less. It is concluded that in Europe there is a high rate of advanced gastric cancer affecting the results. Improved results may be expected if gastric cancer can be detected earlier and if there is radical lymph node dissection. Generally, prospective randomized studies presented by standardized documentation and statistics are urgently needed.

Prognosis of Gastric Cancer Patients with Node-Negative Metastasis following Curative Resection: Outcomes of the Survival and Recurrence

“…Similar results were reported by other authors (25,36,37). Although Japanese surgeons routinely perform extended lymphadenectomy for gastric cancer patients without distant metastasis, many western investigators have reported that D2 or more extended lymphadenectomy could not improve the prognosis of gastric cancer significantly compared with D1 lymphadenectomy, which is generally accepted by surgeons in western countries (38)(39)(40)(41)(42)(43). Nevertheless, other investigators have stated that D2 lymph node dissection might improve the survival of patients with lymph node-negative gastric carcinoma (25,44,45).…”

Rationale for extensive lymphadenectomy in early gastric carcinoma

“…This relatively small survival benefit must be considered against the increased operative risks of extended lymphadenectomy. Although the operative mortality rate of 2% associated with the ELND procedure seems to be acceptable, some researchers have reported that more aggressive surgery may be related to higher operative morbidity and mortality (Diggory and Cuschieri, 1985;Heberer et al, 1988;Dent et al, 1988). In addition, the ELND procedure presents the disadvantage of longer operation time and greater blood loss, although these factors were not associated with any increase in the mortality rate (de Aretxabala et al, 1987;Smith et al, 1991;Pacelli et al, 1993).…”

“…Japanese surgeons normally perform extensive lymphadenectomy for EGC because a certain proportion of these patients have lymph nodal involvement and carcinoma recurrence is not rare. In contrast, most surgeons in Western countries do not use aggressive surgery (Cuschieri, 1986;Heberer et al, 1988;Irvin and Bridger, 1988;Heesakkers et al, 1994), perhaps because of uncertainty regarding improvement in the survival rate and the high operative risk associated with extensive lymph node dissection (Dent et al, 1988;Heberer et al, 1988;Irvin and Bridger, 1988).To evaluate the therapeutic value of extensive lymphadenectomy in EGC, we analysed retrospectively the causes of death after surgery and compared the 10 year disease-specific survival rate in patients who had received extensive lymphadenectomy with patients who had received simple gastric resection. (LLND).…”

Early gastric cancer: Report of 58 cases

“…In Europe and the United States, considerably lower rates 8.8% and 4% of all resected cases, respectively, have been reported [12,13] which suggests that some EGC are being missed in Western countries. However, recent studies [7,14] describe an increasing frequency of diagnosed EGC in Western countries.…”