Surgery Matters: Progress in Surgical Management of Gastric Cancer

Abstract

Opinion statementThe surgical treatment of gastric carcinoma has progressed significantly in the past few decades. A major milestone was the establishment of multimodal therapies for locally advanced tumours. Improvements in the technique of endoscopic resection have supplanted surgery in the early stages of many cases of gastric cancer. In cases in which an endoscopic resection is not possible, surgical limited resection procedures for the early stages of carcinoma are an equal alternative to gastrectomy in the field of oncology. Proximal gastrectomy is extensively discussed in this context. Whether proximal gastrectomy leads to a better quality of life and better nutritional well-being than total gastrectomy depends on the reconstruction chosen. The outcome cannot be conclusively assessed at present. For locally advanced stages, total or subtotal gastrectomy with D2 lymphadenectomy is now the global standard. A subtotal gastrectomy requires sufficiently long tumour-free proximal resection margins. Recent data indicate that proximal margins of at least 3 cm for tumours with an expansive growth pattern and at least 5 cm for those with an infiltrative growth pattern are sufficient. The most frequently performed reconstruction worldwide following gastrectomy is the Roux-en-Y reconstruction. However, there is evidence that pouch reconstruction is superior in terms of quality of life and nutritional well-being. Oncological gastric surgery is increasingly being performed laparoscopically. The safety and oncological equivalency were first demonstrated for early carcinomas and then for locally advanced tumours, by cohort studies and RCTs. Some studies suggest that laparoscopic procedures may be advantageous in early postoperative recovery. Robotic gastrectomy is also increasing in use. Preliminary results suggest that robotic gastrectomy may have added value in lymphadenectomy and in the early postoperative course. However, further studies are needed to substantiate these results. There is an ongoing debate about the best treatment option for gastric cancer with oligometastatic disease. Preliminary results indicate that certain patient groups could benefit from resection of the primary tumour and metastases following chemotherapy. However, the exact conditions in which patients may benefit have yet to be confirmed by ongoing trials.

Exploring Outcomes of Remnant Gastric Cancer: Literature Review

“…Therefore, surgeons have to enhance their surgical expertise and skills to address the difficult condition known as remnant gastric cancer, which exists today and will in the future. Furthermore, the significance of adhering to oncologic principles for oncology surgery in all surgeries involving remnant stomach cancer cannot be overstated (34)(35).…”

Efficacy and safety of totally laparoscopic gastrectomy with Uncut Roux-en-Y for gastric cancer: A dual-center retrospective study

“…Clinical information of patients (January 2016 to January 2022) who underwent TLDG or TLTG combined with digestive tract reconstruction at Fujian Provincial Hospital and the First A liated Hospital of Fujian Medical University were analyzed. Screen GC patients according to the following requirements: (1) Diagnosis as gastric adenocarcinoma by preoperative endoscopy and pathology; (2) The TNM stage (I to III) ; (3) Receiving TLDG or TLTG combined with digestive tract reconstruction; (4) Clinical information is complete (including preoperative and postoperative endoscopy, computed tomography (CT), pathology); (5) Digestive tract reconstruction limited to URY or RY. Exclusion criteria: (1) History of other malignant tumors; (2) Transfer to laparotomy or small incision assisted anastomosis; (3) Non-surgical radical therapy was performed before surgery, such as radiotherapy, chemotherapy or endoscopic resection; (4) Emergency operation; (5) Patients lost to follow-up.…”

“…Radical surgery is currently recommended for patients with initially operable gastric cancer (GC) [1][2][3][4]. With the innovation of laparoscopic instruments and the widespread application of minimally invasive technologies in GC [5,6], laparoscopy-assisted gastrectomy (LAG) has transitioned to totally laparoscopic gastrectomy (TLG) [7][8][9].…”

Efficacy and safety of totally laparoscopic gastrectomy with uncut Roux-en-Y for gastric cancer: a dual-center retrospective study

“…Radical surgery is currently recommended for patients with initially operable gastric cancer (GC) [ 1 – 4 ]. With the innovation of laparoscopic instruments and the widespread application of minimally invasive technologies in GC [ 5 , 6 ], laparoscopy-assisted gastrectomy (LAG) has transitioned to totally laparoscopic gastrectomy (TLG) [ 7 – 9 ].…”