Surgical Management of Gastric Cancer: A Systematic Review

Abstract

Gastric cancer is the fifth most common cancer worldwide, and it is responsible for 7.7% of all cancer deaths. Despite advances in the field of oncology, where radiotherapy, neo and adjuvant chemotherapy may improve the outcome, the only treatment with curative intent is represented by surgery as part of a multimodal therapy. Two concepts may be adopted in appropriate cases, neoadjuvant treatment before gastrectomy (G) or primary surgical resection followed by chemotherapy. Such an approach, combined with early detection and better screening, has led to a decrease in the overall incidence of gastric cancer. Unfortunately, malignant tumors of the stomach are often diagnosed in locally advanced or metastatic stages when the median overall survival remains poor. Surgical care in these cases must be provided by a multidisciplinary team in a high-volume center. Important surgical aspects such as optimum resection margins, surgical technique, and number of harvested lymph nodes are important factors for patient outcomes. The standardization of surgical treatment of gastric cancer in accordance with the patient’s profile is of decisive importance for a better outcome. This review aims to summarize the current standards in the surgical treatment of gastric cancer.

The Value of Whole-Tumor Histogram and Texture Analysis Using Intravoxel Incoherent Motion in Differentiating Pathologic Subtypes of Locally Advanced Gastric Cancer

“…In China, gastric cancer (GC) has the second-highest cancer burden and the third most common cause of cancer-related deaths (with an age-standardized rate of incidence of 20.6 per 100,000 people, an age-standardized rate of mortality 15.9 per 100,000 population), and most patients are diagnosed at advanced disease stages (1). Patients presenting with locally advanced gastric cancer (LAGC) encounter problems associated with precise diagnoses and personalized treatment plans (2,3) since tumor differentiation, Lauren classifications, and the presence of signet-ring cells can influence prognoses and treatment determinations (4)(5)(6). Lauren classifications are convenient and easy to implement and have good interobserver agreement (7).…”

Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: An Updated Systematic Review

“…Over the last three decades, surgeons have been increasingly adopting laparoscopic surgery for GC, due to its better short-term outcomes [8][9][10][11]. In particular, laparoscopic gastrectomy (LG) has been routinely used for early gastric cancer (EGC) treatment [8][9][10][11].…”

“…Over the last three decades, surgeons have been increasingly adopting laparoscopic surgery for GC, due to its better short-term outcomes [8][9][10][11]. In particular, laparoscopic gastrectomy (LG) has been routinely used for early gastric cancer (EGC) treatment [8][9][10][11]. Despite the strong interest, LG has been witnessing a rather rare use, due to poor evidence of long-term survival outcomes and concerns about oncological relevance of surgical resection [8][9][10][11].…”

“…In particular, laparoscopic gastrectomy (LG) has been routinely used for early gastric cancer (EGC) treatment [8][9][10][11]. Despite the strong interest, LG has been witnessing a rather rare use, due to poor evidence of long-term survival outcomes and concerns about oncological relevance of surgical resection [8][9][10][11]. Outcomes of robust trials proved the oncological safety of LG compared with open gastrectomy (OG) by showing non-inferiority in survival [8][9][10][11].…”

“…Despite the strong interest, LG has been witnessing a rather rare use, due to poor evidence of long-term survival outcomes and concerns about oncological relevance of surgical resection [8][9][10][11]. Outcomes of robust trials proved the oncological safety of LG compared with open gastrectomy (OG) by showing non-inferiority in survival [8][9][10][11]. Moreover, technical problems related to total gastrectomy as well as D2 lymphadenectomy prevent the diffusion of laparoscopic surgery, as D2 lymphadenectomy entails the removal of node stations along celiac trunk, left gastric artery and hepatic pedicle [8].…”