Ten Thousand Consecutive Gastrectomies for Gastric Cancer: Perspectives of a Master Surgeon

Abstract

As radical gastrectomy with lymph node dissection is currently the best strategy to cure gastric cancer, the role of the surgeon remains quite important in conquering it. Dr. Sung Hoon Noh, a surgeon and surgical oncologist specializing in gastric cancer, has treated gastric cancer for 30 years and has conducted over 10000 cases of gastrectomy for gastric cancer. He first adapted an electrocautery device into gastric cancer surgery and has led standardization of surgical procedures, including spleen preserving gastrectomy. His procedures based on patient-oriented insights have become the basis of the concept of enhanced recovery after surgery. He has also contributed to improving patient's survival through adoption of a multidisciplinary approach: he proved the benefit of adjuvant chemotherapy after radical D2 gastrectomy for stage II/III gastric cancer in clinical trials, updating treatment guidelines throughout the world. Dr. Noh also opened the era of precision medicine for treating gastric cancer, as he developed and validated a mRNA expression based algorithm to predict prognosis and response to chemotherapy. This article reviews his contribution and long history of service in the field of gastric cancer. The perspectives of this master surgeon, based on his profound experience and insights, will outline directions for integrative multidisciplinary health care and how can surgeons prepare for the future.

Yield of staging laparoscopy in gastric cancer is influenced by Laurén histologic subtype

“…Presumably, advances in technology and a better understanding of GC biology (the Cancer Genome Atlas) will successively favor tailored surgery . Large scale prospective studies with the standardized procedure of SL and peritoneal washings will allow to a distinct selected group of GC patients with a high risk of peritoneal metastases and tailor the multidisciplinary treatment accordingly.…”

Clinical Implications of Microsatellite Instability in Early Gastric Cancer

“…Variable molecular characteristics are responsible for the diverse clinical features and prognosis [789] in patients with gastric cancer. Discovering biomarkers related to LN metastasis and prognosis are essential for improving patient care [10].…”

A study of outcomes, technical safety, and feasibility of D‐2 lymphadenectomy in gastric cancer

“…Spleen-and pancreaspreserving D-2 lymphadenectomy improves overall survival, with acceptable perioperative morbidity and mortality. [11][12][13][14][15][16][17][18] Outcomes of D-2 lymphadenectomy are influenced by surgical skills and the volume of center. Japanese centers had a high volume of cases and relatively better surgical skills and experience.…”

“…Results of these trials can no longer be accepted in the current practice scenario as there is no benefit of the routine resection of distal pancreas and spleen. Spleen‐ and pancreas‐preserving D‐2 lymphadenectomy improves overall survival, with acceptable perioperative morbidity and mortality 11‐18 …”