Surgical Treatment of Gastric Carcinoma

Hoon Hur; Cho Hyun Park

doi:10.4166/kjg.2009.54.2.83

Journal List > Korean J Gastroenterol > v.54(2) > 1006624

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Hur and Park: Surgical Treatment of Gastric Carcinoma

Review

Korean J Gastroenterol 2009;54(2):83-98.

Published online: 21 February 2009

DOI: https://doi.org/10.4166/kjg.2009.54.2.83

Surgical Treatment of Gastric Carcinoma

Hoon Hur, M.D., Cho Hyun Park, M.D., Ph.D.

Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to: Cho Hyun Park, M.D. Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, 505, Banpo 4-dong, Seocho-gu, Seoul 137-701, Korea Tel: +82-2-2258-6609, Fax: +82-2-595-2992 E-mail: chpark@catholic.ac.kr

Abstract

The gastric cancer is the most common cancer in Korea. The only treatment modality showing improved survival for gastric cancer is curative surgical resection, which comprises the resection of stomach, proper lymphadenectomy, and reconstruction. However, specific surgical procedures should be decided according to the location of the cancer, advancement of the tumor, and patients’ condition. Surgical treatment for gastric cancer has been developed toward two directions that are minimal invasive surgery for early gastric cancer and multi-disciplinary approach for advanced gastric cancer. Laparoscopic surgery for early gastric cancer has been accepted for minimally invasive surgery. Moreover, the advancement of diagnostic tools to assess biological aggressiveness of the tumor enables physicians to perform endoscopic resection or minimized resection for early gastric cancer. Recently, surgeons try to extend the application of laparoscopic gastric resection and D2 lymphadenectomy to advanced gastric cancer. However, technical and oncological evidences based on clinical trials should be filed up before adopting it as a standard therapy. In case of advanced gastric cancer, in addition to radical surgery, various treatment modalities including chemotherapy, radiation, and molecular target therapy also have been applied in many clinical trials. However, it should be stressed that a prerequisite for precise evaluation of the efficacy of these combined treatment modalities would be the standardization of surgical procedure.

Keywords: Gastric adenocarcinoma, Surgical treatment, Minimal invasive surgery, Multidisciplinary approach

REFERENCES

1. Ferlay J, Bray F, Pisani P, DM P. GLOBOCAN 2002: cancer incidence, mortality and prevalence worldwide. IARC Press: Lyon;2004.

2. Kim JP. Current status of surgical treatment of gastric cancer. J Surg Oncol. 2002; 79:79–80.

3. Nakajima T. Gastric cancer treatment guidelines in Japan. Gastric Cancer. 2002; 5:1–5.

4. Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet. 1996; 347:995–999.

5. Japanese Gastric Cancer A. Japanese classification of gastric carcinoma - 2nd English edition. Gastric Cancer. 1998; 1:10–24.

6. Cuschieri A, Weeden S, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer: longterm results of the MRC randomized surgical trial. Surgical Cooperative Group. Br J Cancer. 1999; 79:1522–1530.

7. Bonenkamp JJ, Songun I, Hermans J, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995; 345:745–748.

8. Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med. 1999; 340:908–914.

9. Sasako M. Clinical trials of surgical treatment of malignant diseases. Int J Clin Oncol. 2005; 10:165–170.

10. Degiuli M, Sasako M, Calgaro M, et al. Morbidity and mortality after D1 and D2 gastrectomy for cancer: interimanalysis of the Italian Gastric Cancer Study Group (IGCSG) randomised surgical trial. Eur J Surg Oncol. 2004; 30:303–308.

11. Degiuli M, Sasako M, Ponti A, Calvo F. Survival results of a multicentre phase II study to evaluate D2 gastrectomy for gastric cancer. Br J Cancer. 2004; 90:1727–1732.

12. Degiuli M, Sasako M, Ponti A, Soldati T, Danese F, Calvo F. Morbidity and mortality after D2 gastrectomy for gastric cancer: results of the Italian Gastric Cancer Study Group prospective multicenter surgical study. J Clin Oncol. 1998; 16:1490–1493.

13. Pacelli F, Doglietto GB, Bellantone R, Alfieri S, Sgadari A, Crucitti F. Extensive versus limited lymph node dissection for gastric cancer: a comparative study of 320 patients. Br J Surg. 1993; 80:1153–1156.

14. Siewert JR, Bottcher K, Roder JD, Busch R, Hermanek P, Meyer HJ. Prognostic relevance of systematic lymph node dissection in gastric carcinoma. German Gastric Carcinoma Study Group. Br J Surg. 1993; 80:1015–1018.

15. Korenaga D, Baba H, Kakeji Y, et al. Comparison of R1 and R2 gastrectomy for gastric cancer in patients over 80 years of age. J Surg Oncol. 1991; 48:136–141.

16. Lee WJ, Lee WC, Houng SJ, et al. Survival after resection of gastric cancer and prognostic relevance of systematic lymph node dissection: twenty years experience in Taiwan. World J Surg. 1995; 19:707–713.

17. Ikeguchi M, Oka S, Gomyo Y, Tsujitani S, Maeta M, Kaibara N. Prognostic benefit of extended radical lymphadenectomy for patients with gastric cancer. Anticancer Res. 2000; 20:1285–1289.

18. Onate-Ocana LF, Aiello-Crocifoglio V, Mondragon-Sanchez R, Ruiz-Molina JM. Survival benefit of D2 lympadenectomy in patients with gastric adenocarcinoma. Ann Surg Oncol. 2000; 7:210–217.

19. Katai H, Sano T, Fukagawa T, Shinohara H, Sasako M. Prospective study of proximal gastrectomy for early gastric cancer in the upper third of the stomach. Br J Surg. 2003; 90:850–853.

20. Harrison LE, Karpeh MS, Brennan MF. Total gastrectomy is not necessary for proximal gastric cancer. Surgery. 1998; 123:127–130.

21. Buhl K, Schlag P, Herfarth C. Quality of life and functional results following different types of resection for gastric carcinoma. Eur J Surg Oncol. 1990; 16:404–409.

22. Bozzetti F, Marubini E, Bonfanti G, Miceli R, Piano C, Gennari L. Subtotal versus total gastrectomy for gastric cancer: five-year survival rates in a multicenter randomized Italian trial. Italian Gastrointestinal Tumor Study Group. Ann Surg. 1999; 230:170–178.

23. Bozzetti F, Bonfanti G, Bufalino R, et al. Adequacy of margins of resection in gastrectomy for cancer. Ann Surg. 1982; 196:685–690.

24. Papachristou DN, Fortner JG. Local recurrence of gastric adenocarcinomas after gastrectomy. J Surg Oncol. 1981; 18:47–53.

25. Ishikawa M, Kitayama J, Kaizaki S, et al. Prospective randomized trial comparing Billroth I and Roux-en-Y procedures after distal gastrectomy for gastric carcinoma. World J Surg. 2005; 29:1415–1420.

26. Chin AC, Espat NJ. Total gastrectomy: options for the restoration of gastrointestinal continuity. Lancet Oncol. 2003; 4:271–276.

27. El Halabi HM, Lawrence W. Clinical results of various reconstructions employed after total gastrectomy. J Surg Oncol. 2008; 97:186–192.

28. Endo S, Nishida T, Nishikawa K, et al. Motility of the pouch correlates with quality of life after total gastrectomy. Surgery. 2006; 139:493–500.

29. Fujiwara Y, Kusunoki M, Nakagawa K, Tanaka T, Hatada T, Yamamura T. Evaluation of J-pouch reconstruction after total gastrectomy: rho-double tract vs. J-pouch double tract. Dig Surg. 2000; 17:475–481.

30. Kono K, Iizuka H, Sekikawa T, et al. Improved quality of life with jejunal pouch reconstruction after total gastrectomy. Am J Surg. 2003; 185:150–154.

31. Nakane Y, Okumura S, Akehira K, et al. Jejunal pouch reconstruction after total gastrectomy for cancer. A randomized controlled trial. Ann Surg. 1995; 222:27–35.

32. Nomura E, Shinohara H, Mabuchi H, Sang-Woong L, Sonoda T, Tanigawa N. Postoperative evaluation of the jejunal pouch reconstruction following proximal and distal gastrectomy for cancer. Hepatogastroenterology. 2004; 51:1561–1566.

33. Maruyama K, Okabayashi K, Kinoshita T. Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg. 1987; 11:418–425.

34. Sawai K, Takahashi T, Suzuki H. New trends in surgery for gastric cancer in Japan. J Surg Oncol. 1994; 56:221–226.

35. Yasuda K, Shiraishi N, Suematsu T, Yamaguchi K, Adachi Y, Kitano S. Rate of detection of lymph node metastasis is correlated with the depth of submucosal invasion in early stage gastric carcinoma. Cancer. 1999; 85:2119–2123.

36. An JY, Baik YH, Choi MG, Noh JH, Sohn TS, Kim S. Predictive factors for lymph node metastasis in early gastric cancer with submucosal invasion: analysis of a single institutional experience. Ann Surg. 2007; 246:749–753.

37. Higashi H, Natsugoe S, Ishigami S, et al. Distribution of lymph node metastasis including micrometastasis in gastric cancer with submucosal invasion. World J Surg. 2003; 27:455–459.

38. Kunisaki C, Shimada H, Ono H, et al. Predictive factors for pancreatic fistula after pancreaticosplenectomy for advanced gastric cancer in the upper third of the stomach. J Gastrointest Surg. 2006; 10:132–137.

39. Kurihara N, Kubota T, Otani Y, et al. Lymph node metastasis of early gastric cancer with submucosal invasion. Br J Surg. 1998; 85:835–839.

40. Lo SS, Wu CW, Chen JH, et al. Surgical results of early gastric cancer and proposing a treatment strategy. Ann Surg Oncol. 2007; 14:340–347.

41. Park DJ, Lee HK, Lee HJ, et al. Lymph node metastasis in early gastric cancer with submucosal invasion: feasibility of minimally invasive surgery. World J Gastroenterol. 2004; 10:3549–3552.

42. Shimoyama S, Seto Y, Yasuda H, Kaminishi M. Wider indications for the local resection of gastric cancer by adjacent lymphadenectomy. J Surg Oncol. 2000; 75:157–164.

43. Song KY, Hyung WJ, Kim HH, et al. Is gastrectomy mandatory for all residual or recurrent gastric cancer following endoscopic resection? A large-scale Korean multicenter study. J Surg Oncol. 2008; 98:6–10.

44. Ryu KW, Choi IJ, Doh YW, et al. Surgical indication for non-curative endoscopic resection in early gastric cancer. Ann Surg Oncol. 2007; 14:3428–3434.

45. Hiki N, Kaminishi M. Pylorus-preserving gastrectomy in gastric cancer surgery–open and laparoscopic approaches. Langenbecks Arch Surg. 2005; 390:442–447.

46. Shibata C, Shiiba KI, Funayama Y, et al. Outcomes after pylorus-preserving gastrectomy for early gastric cancer: a prospective multicenter trial. World J Surg. 2004; 28:857–861.

47. Imada T, Rino Y, Takahashi M, et al. Postoperative functional evaluation of pylorus-preserving gastrectomy for early gastric cancer compared with conventional distal gastrectomy. Surgery. 1998; 123:165–170.

48. Nishikawa K, Kawahara H, Yumiba T, et al. Functional characteristics of the pylorus in patients undergoing pylorus–preserving gastrectomy for early gastric cancer. Surgery. 2002; 131:613–624.

49. Park DJ, Lee HJ, Jung HC, Kim WH, Lee KU, Yang HK. Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis. World J Surg. 2008; 32:1029–1036.

50. Furukawa H, Hiratsuka M, Imaoka S, et al. Phase II study of limited surgery for early gastric cancer: segmental gastric resection. Ann Surg Oncol. 1999; 6:166–170.

51. Kobayashi T, Kazui T, Kimura T. Surgical local resection for early gastric cancer. Surg Laparosc Endosc Percutan Tech. 2003; 13:299–303.

52. Ludwig K, Klautke G, Bernhard J, Weiner R. Minimally invasive and local treatment for mucosal early gastric cancer. Surg Endosc. 2005; 19:1362–1366.

53. Nozaki I, Kubo Y, Kurita A, et al. Longterm outcome after laparoscopic wedge resection for early gastric cancer. Surg Endosc. 2008; 22:2665–2669.

54. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994; 4:146–148.

55. Hayashi H, Ochiai T, Shimada H, Gunji Y. Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc. 2005; 19:1172–1176.

56. Huscher CG, Mingoli A, Sgarzini G, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005; 241:232–237.

57. Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y. A randomized controlled trial comparing openvs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery. 2002; 131:S306–S311.

58. Lee JH, Han HS. A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc. 2005; 19:168–173.

59. Jeong O, Park YK. Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc. 2009. in press.

60. Okabe H, Obama K, Tanaka E, et al. Intracorporeal esoph-agojejunal anastomosis after laparoscopic total gastrectomy for patients with gastric cancer. Surg Endosc. 2008. in press.

61. Okabe H, Satoh S, Inoue H, et al. Esophagojejunostomy through minilaparotomy after laparoscopic total gastrectomy. Gastric Cancer. 2007; 10:176–180.

62. Usui S, Nagai K, Hiranuma S, Takiguchi N, Matsumoto A, Sanada K. Laparoscopy-assisted esophagoenteral anastomosis using endoscopic purse-string suture instrument “Endo-PSI (II)” and circular stapler. Gastric Cancer. 2008; 11:233–237.

63. Hur H, Jeon HM, Kim W. Laparoscopic pancreas- and spleen-preserving D2 lymph node dissection in advanced (cT2) upper-third gastric cancer. J Surg Oncol. 2008; 97:169–172.

64. Hyung WJ, Lim JS, Song J, Choi SH, Noh SH. Laparoscopic spleen-preserving splenic hilar lymph node dissection during total gastrectomy for gastric cancer. J Am Coll Surg. 2008; 207:e6–11.

65. Mochiki E, Toyomasu Y, Ogata K, et al. Laparoscopically assisted total gastrectomy with lymph node dissection for upper and middle gastric cancer. Surg Endosc. 2008; 22:1997–2002.

66. Sakuramoto S, Kikuchi S, Futawatari N, et al. Laparoscopy-assisted pancreas- and spleen-preserving total gastrectomy for gastric cancer as compared with open total gastrectomy. Surg Endosc. 2009. [In print].

67. Han HS, Kim YW, Yi NJ, Fleischer GD. Laparoscopy-assisted D2 subtotal gastrectomy in early gastric cancer. Surg Laparosc Endosc Percutan Tech. 2003; 13:361–365.

68. Song KY, Kim SN, Park CH. Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer: technical and oncologic aspects. Surg Endosc. 2008; 22:655–659.

69. Kawamura H, Homma S, Yokota R, et al. Inspection of safety and accuracy of D2 lymph node dissection in laparoscopy-assisted distal gastrectomy. World J Surg. 2008; 32:2366–2370.

70. Tokunaga M, Hiki N, Fukunaga T, et al. Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection following standardization–a preliminary study. J Gastrointest Surg. 2009; 13:1058–1063.

71. Uyama I, Sugioka A, Matsui H, Fujita J, Komori Y, Hasumi A. Laparoscopic D2 lymph node dissection for advanced gastric cancer located in the middle or lower third portion of the stomach. Gastric Cancer. 2000; 3:50–55.

72. Hur H, Jeon HM, Kim W. Laparoscopy-assisted distal gastrectomy with D2 lymphadenectomy for T2b advanced gastric cancers: three years' experience. J Surg Oncol. 2008; 98:515–519.

73. Huscher CG, Mingoli A, Sgarzini G, et al. Totally laparoscopic total and subtotal gastrectomy with extended lymph node dissection for early and advanced gastric cancer: early and longterm results of a 100-patient series. Am J Surg. 2007; 194:839–844.

74. Hwang SI, Kim HO, Yoo CH, Shin JH, Son BH. Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer. Surg Endosc. 2009; 23:1252–1258.

75. Mingoli A, Sgarzini G, Binda B, et al. Totally laparoscopic approach for treatment of early and advanced gastric cancer. J Am Coll Surg. 2007; 204:187–188.

76. Ziqiang W, Feng Q, Zhimin C, et al. Comparison of laparoscopically assisted and open radical distal gastrectomy with extended lymphadenectomy for gastric cancer management. Surg Endosc. 2006; 20:1738–1743.

77. Borgstein PJ, Meijer S, Pijpers R. Intradermal blue dye to identify sentinel lymph-node in breast cancer. Lancet. 1997; 349:1668–1669.

78. Hayashi H, Ochiai T, Mori M, et al. Sentinel lymph node mapping for gastric cancer using a dual procedure with dye-and gamma probe-guided techniques. J Am Coll Surg. 2003; 196:68–74.

79. Hiratsuka M, Miyashiro I, Ishikawa O, et al. Application of sentinel node biopsy to gastric cancer surgery. Surgery. 2001; 129:335–340.

80. Kim MC, Kim HH, Jung GJ, et al. Lymphatic mapping and sentinel node biopsy using ^99mTc tin colloid in gastric cancer. Ann Surg. 2004; 239:383–387.

81. Kitagawa Y, Fujii H, Mukai M, Kubota T, Otani Y, Kitajima M. Radio-guided sentinel node detection for gastric cancer. Br J Surg. 2002; 89:604–608.

82. Nakahara T, Kitagawa Y, Yakeuchi H, et al. Preoperative lymphoscintigraphy for detection of sentinel lymph node in patients with gastric cancer–initial experience. Ann Surg Oncol. 2008; 15:1447–1453.

83. Zulfikaroglu B, Koc M, Ozmen MM, Kucuk NO, Ozalp N, Aras G. Intraoperative lymphatic mapping and sentinel lymph node biopsy using radioactive tracer in gastric cancer. Surgery. 2005; 138:899–904.

84. Mikhail AA, Orvieto MA, Billatos ES, et al. Robotic-assisted laparoscopic prostatectomy: first 100 patients with one year of follow-up. Urology. 2006; 68:1275–1279.

85. Rodriguez E, Kypson AP, Moten SC, Nifong LW, Chitwood WR. Robotic mitral surgery at East Carolina University: a 6 year experience. Int J Med Robot. 2006; 2:211–215.

86. Anderson C, Hellan M, Kernstine K, et al. Robotic surgery for gastrointestinal malignancies. Int J Med Robot. 2007; 3:297–300.

87. Giulianotti PC, Coratti A, Angelini M, et al. Robotics in general surgery: personal experience in a large community hospital. Arch Surg. 2003; 138:777–784.

88. Hashizume K, Tsukahara T, Yamada K, Koyama H, Ushida K. Megasphaera elsdenii JCM1772T normalizes hyperlactate production in the large intestine of fructooligosaccharide-fed rats by stimulating butyrate production. J Nutr. 2003; 133:3187–3190.

89. Song J, Oh SJ, Kang WH, Hyung WJ, Choi SH, Noh SH. Robot-assisted gastrectomy with lymph node dissection for gastric cancer: lessons learned from an initial 100 consecutive procedures. Ann Surg. 2009; 249:927–932.

90. Yonemura Y, Wu CC, Fukushima N, et al. Operative morbidity and mortality after D2 and D4 extended dissection for advanced gastric cancer: a prospective randomized trial conducted by Asian surgeons. Hepatogastroenterology. 2006; 53:389–394.

91. Kulig J, Popiela T, Kolodziejczyk P, Sierzega M, Szczepan-ik A. Standard D2 versus extended D2 (D2+) lymphadenectomy for gastric cancer: an interim safety analysis of a multicenter, randomized, clinical trial. Am J Surg. 2007; 193:10–15.

92. Wu CW, Hsiung CA, Lo SS, Hsieh MC, Shia LT, Whang-Peng J. Randomized clinical trial of morbidity after D1 and D3 surgery for gastric cancer. Br J Surg. 2004; 91:283–287.

93. Wu CW, Hsiung CA, Lo SS, et al. Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol. 2006; 7:309–315.

94. Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended paraaortic lymphadenectomy–Japan Clinical Oncology Group study 9501. J Clin Oncol. 2004; 22:2767–2773.

95. Kodera Y, Sasako M, Yamamoto S, Sano T, Nashimoto A, Kurita A. Identification of risk factors for the development of complications following extended and superextended lymphadenectomies for gastric cancer. Br J Surg. 2005; 92:1103–1109.

96. Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with paraaortic nodal dissection for gastric cancer. N Engl J Med. 2008; 359:453–462.

97. Brady MS, Rogatko A, Dent LL, Shiu MH. Effect of splenectomy on morbidity and survival following curative gastrectomy for carcinoma. Arch Surg. 1991; 126:359–364.

98. Kwon SJ. Prognostic impact of splenectomy on gastric cancer: results of the Korean Gastric Cancer Study Group. World J Surg. 1997; 21:837–844.

99. Maehara Y, Moriguchi S, Yoshida M, Takahashi I, Korenaga D, Sugimachi K. Splenectomy does not correlate with length of survival in patients undergoing curative total gastrectomy for gastric carcinoma. Univariate and multivariate analyses. Cancer. 1991; 67:3006–3009.

100. Meyer HJ, Jahne J, Wilke H, Pichlmayr R. Surgical treatment of gastric cancer: retrospective survey of 1,704 operated cases with special reference to total gastrectomy as the operation of choice. Semin Surg Oncol. 1991; 7:356–364.

101. Otsuji E, Yamaguchi T, Sawai K, Ohara M, Takahashi T. End results of simultaneous splenectomy in patients undergoing total gastrectomy for gastric carcinoma. Surgery. 1996; 120:40–44.

102. Wanebo HJ, Kennedy BJ, Winchester DP, Stewart AK, Fremgen AM. Role of splenectomy in gastric cancer surgery: adverse effect of elective splenectomy on longterm survival. J Am Coll Surg. 1997; 185:177–184.

103. Maruyama K, Sasako M, Kinoshita T, Sano T, Katai H, Okajima K. Pancreas-preserving total gastrectomy for proximal gastric cancer. World J Surg. 1995; 19:532–536.

104. Yu W, Choi GS, Chung HY. Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer. Br J Surg. 2006; 93:559–563.

105. Sano T, Yamamoto S, Sasako M. Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma: Japan clinical oncology group study JCOG 0110-MF. Jpn J Clin Oncol. 2002; 32:363–364.

106. Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001; 345:725–730.

107. Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006; 355:11–20.

108. Sakuramoto S, Sasako M, Yamaguchi T, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007; 357:1810–1820.

109. Songun I, Keizer HJ, Hermans J, et al. Chemotherapy for operable gastric cancer: results of the Dutch randomised FAMTX trial. The Dutch Gastric Cancer Group (DGCG). Eur J Cancer. 1999; 35:558–562.

110. Miner TJ. Palliative surgery for advanced cancer: lessons learned in patient selection and outcome assessment. Am J Clin Oncol. 2005; 28:411–414.

111. Hartgrink HH, Putter H, Klein Kranenbarg E, Bonenkamp JJ, van de Velde CJ. Value of palliative resection in gastric cancer. Br J Surg. 2002; 89:1438–1443.

112. Medina-Franco H, Contreras-Saldivar A, Ramos-De La Medina A, Palacios-Sanchez P, Cortes-Gonzalez R, Ugarte JA. Surgery for stage IV gastric cancer. Am J Surg. 2004; 187:543–546.

113. Saidi RF, ReMine SG, Dudrick PS, Hanna NN. Is there a role for palliative gastrectomy in patients with stage IV gastric cancer? World J Surg. 2006; 30:21–27.

114. Samarasam I, Chandran BS, Sitaram V, Perakath B, Nair A, Mathew G. Palliative gastrectomy in advanced gastric cancer: is it worthwhile? ANZ J Surg. 2006; 76:60–63.

115. Ouchi K, Sugawara T, Ono H, et al. Therapeutic significance of palliative operations for gastric cancer for survival and quality of life. J Surg Oncol. 1998; 69:41–44.

116. Choi YB. Laparoscopic gatrojejunostomy for palliation of gastric outlet obstruction in unresectable gastric cancer. Surg Endosc. 2002; 16:1620–1626.

117. Fiori E, Lamazza A, Volpino P, et al. Palliative management of malignant antro-pyloric strictures. Gastroenterostomy vs. endoscopic stenting. A randomized prospective trial. Anticancer Res. 2004; 24:269–271.

118. Allum WH, Powell DJ, McConkey CC, Fielding JW. Gastric cancer: a 25-year review. Br J Surg. 1989; 76:535–540.

119. Park DJ, Lee HJ, Kim HH, Yang HK, Lee KU, Choe KJ. Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg. 2005; 92:1099–1102.

120. Park CH, Song KY, Kim SN. Treatment results for gastric cancer surgery: 12 years' experience at a single institute in Korea. Eur J Surg Oncol. 2008; 34:36–41.

Table 1.

Guidelines according to Each Society

	NCCN	JGCA	KGCA
T1a	Medically fit	Differentiated,	Unspecified
	- Surgery or	≤2 cm
	EMR	- EMR
	Medically unfit	Others
	- EMR	- MG
EGC except	Surgery	T1N1 with less	sm cancer
for T1a		2 cm	- SG recommand
		- MG
		T1N1 with
		lager 2 cm
		- SG
T2 or high	Preoperative	SG	SG
	CTx
	Surgery
M1	Palliative	Palliative	Palliative

EMR, endoscopic mucosal resection; MG, modified gastrectomy (D1+α or β); SG, standard gastrectomy (D2); CTx, chemotherapy; JGCA, Japanese Gastric Cancer Association; KGCA, The Korean Gastric Cancer Association

Table 2.

Randomized Controlled Clinical Trials for Evaluation of Difference between D1 and D2 Lymphadenectomy

		n	Morbidity		Mortality		5 yr survival
		n	Rate	p-value	Rate	p-value	Rate	p-value
MRC	D1	200	28.0%	＜0.001	6.5%	0.04	35%	0.72
	D2	200	46.0%		13.0%		33%
Dutch	D1	498	25.0%	＜0.001	4%	0.004	30%	0.53
	D2	498	43.0%		10%		35%
Italian	D1	76	10.5%	NS	1.3%	NS	Not evaluated
	D2	86	16.3%		0%

Table 3.

Retrospective Reports about D2 Lymph Node Dissection for Gastric Cancer

Author	Year	Patients	Mortality	Morbidity	5 yr survival	Et al.
Korenaga et al.¹⁵	1991	D1: 35	0%	11.4%	55.8%	Over 80 age
		D2: 27	0%	18.5%	65.4%
Lee et al.¹⁶	1995	D1: 182	5.5%	Not reported	24.7%	Comparisons
		D1 or D2: 249	5.4%		30.7%	according to periods
		D2: 221	3.1%		36.8%
		D2 or D3: 299	2.0%		47.5%
Ikeguchi et al.¹⁷	2000	D0 or D1: 137	3.7%	7.3%	Stage I: NS
		D2: 524	2.5%	9.0%	Stage II: NS
		D3: 221	1.4%	10.4%	Stage III: D3＞D2
					Stage IV: NS
Onate-Ocana et al.¹⁸	2000	D1: 106	6.8%	16.9%	35.1%
		D2: 113	8.6%	19.5%	64.0%

Table 4.

Comparison of Advantage and Disadvantage for Billroth-I and Billrorth-II

	Billroth-I (Gastroduodenostomy)	Billroth-II (Gastrojejunostomy)
Advantage	Physiologic, nutritional effect Short operation time	Possible enough resection Reduced occurrence rate of stasis
Disadvantage	Limitation of resection for duodenal bulb, stomach and lymph node	Possible of infection Long operation time
	Mobilization of duodenum Delayed emptying time	Not physiologic pathway for food Reflux gastritis

Table 5.

Studies about Relationship between Lymph Node Metastasis and Clinicopathologic Factors

Study	Year of publication, country	No. of positive LN (% of LN meta)	LN dissection	Variablesin relation to LN
Yasuda et al.³⁵	1999, Japan	sm: 118 (13.6)	NR	Tumor size Macroscopic type
				Histological type
				Depth of invasion
An et al.³⁶	2007, Korea	sm: 1043 (19.4)	NR	Tumor size
				Histological type
				Depth of invasion
				Lymphatic invasion
				Perineural invasion
Higashi et al.³⁷	2003, Japan	sm: 118 (19.5)	Median 24 LNs	Macroscopic type
				Depth of invasion
				Vascular invasion
Kunisaki et al.³⁸	2006, Japan	sm: 615 (19.3)	D1-D3	Age
				Sex
				Tumor location
				Tumor size
				Macroscopic type
				Histologic type
				Lymphatic invasion
				Vascular invasion
Kurihara et al.³⁹	1998, Japan	sm: 245 (13.9)	D2	Age
				Sex
				Tumor location
Lo et al.⁴⁰	2007, Taiwan	m: 272 (4.4)	D1-D2	Tumor size
		sm: 207 (20.3)
Park et al.⁴¹	2004, Korea	sm: 105 (22.9)	NR	Sex
				Tumor location
				Tumor size
				Macroscopic type
				Histologic type
				Depth of tumor invasion
				Lymphatic invasion
Shimoyama et al.⁴²	2000, Japan	m: 345 (3.2)	D1-D2	Tumor size
		sm: 266 (19.2)		Macroscopic type

LN, lymph node; NR, not reported.

Table 6.

Studies about Pylorus Preserving Gastrectomy

Study	Study type	No. of patients	Evaluation	Superiority
Shibata et al.⁴⁶	RCT	PPG (36)	Body weight	NS
		CDG (38)	Food intake	NS
			Early dumping syndrome	PPG
Imada et al.⁴⁷	NR	PPG (20)	Gallbladder function	PPG
		CDG (25)	Gastric emptying	PPG
			Reflux gastritis	PPG
			Body weight loss	NS
Nishikawa et al.⁴⁸	Retrospective	PPG (12)	Postprandial symptom	PPG
		CDG (12)	Dumping socres	PPG
			Gastric emptying time	PPG
Park et al.⁴⁹	Retrospective	PPG (21)	Postprandial symptom	PPG, late period
		CDG (17)	Nutritional marker	NS
			Gastric emptying time	PPG, soft

RTC, randomized controlled trial; NR, not recorded; PPG, pylorus preserving gastrectomy; CDG, conventional distal gastrectomy; NS, non-specific.

Table 7.

Clinical Trials about Comparison of Laparoscopy and Open Gastrectomy

Study	Year of publication, country	No. of patients		LN dissection	Indication
Study	Year of publication, country	LADG	ODG	LN dissection	Indication
Hayshi et al.⁵⁵	2005, Japan	14	14	D1＋α	T1a or T1b
Huscher et al.⁵⁶	2005, Italy	30	29	D1, D2	All stages
Kitano et al.⁵⁷	2002, Japan	14	14	D1＋α	T1aN0
Lee et al.⁵⁸	2002, Korea	24	23	D2	T1a or T1b

LN, lymph nodes; LADG, laparoscopy-assisted distal gastrectomy; ODG, open distal gastrectomy.

Table 8.

Reports about Laparoscopy D2 Lymph Node Dissection for Gastric Cancer

Author	Year	Patients	Mean operation time (min)	Morbidity (%)	Et al.
Han et al.⁶⁷	2003	D2: 20	261.8	1 (5)	LADG one arm
Song et al.⁶⁸	2008	LADG D2: 44	264.0	5 (11)
		ODG D2: 31	184.2	6 (19)
Kawamura et al.⁶⁹	2008	LADG D2: 53	276.9	3 (5.7)
		ODG D2: 67	267.8	11 (16.7)
Tokunaga et al.⁷⁰	2009	D2: 42	253.0	2 (5)
		D1＋β: 179	224.0	16 (9)

Table 9.

Studies on Sentinel Nodes in Gastric Cancer

Study	No. of patients	Indication	Method	Timing	Surgery	Incidence of ^metastasis (%)		Sensitivity	Accuracy
Study	No. of patients	Indication	Method	Timing	Surgery	SNs	Non-SNs	Sensitivity	Accuracy
Hayashi	31	T1-2N0M0	⁹9mTec tin	Tec 18 hr before	BNs, HNs and D2	22	−	100%	100%
et al.⁷⁸			colloid and	and blue dye	LND
			blue dye	intraoperative
Hiratsuka	74	T1-2N0M0	ICG	At laparotomy	SNs and D2 LND	4	1	90%	99%
et al.⁷⁹
Kim et al.⁸⁰	46	T1-2N0M0	⁹9mTec tin	1 to 3 hr before	SNs and D2 LND	26	16	84.6%	−
			colloid	oepration
Kitagawa	145	T1-2N0M0	⁹9mTec tin	16 hr before surgery	HNs removed and	7.8	0.3	−	98.6%
et al.⁸¹			colloid	and 2 hr preop	D2 LND
Nakahara	80	T1N0M0	⁹9mTec tin	24 hr before surgery	D2 LND	4.7	?	100%	−
et al.⁸²			colloid
Zulfikaroglu	32	T1-3	⁹9mTec tin	2 hr before surgery	D2-α LND	90	0	100%	97%
et al.⁸³			colloid

SNs, sentinel nodes; BNs, blue nodes; HNs, hot nodes; LND, lymph node dissection; ICG, indocyanine green.

Table 10.

Results of Clinical Trials for Over D2 Lymph Node Dissection

Institution	Year	Patients	Morbidity	Mortality	5 yr survival	Et al.
Shizuoka cancer center⁹⁰	2006	D2: 128	22.0%	0.8%	Not reported	AGC patients
		D4: 128	38.0%	0.8%
Polish gastric cancer study group⁹¹	2007	D2: 141	27.7%	4.9%	Not reported
		D4: 134	21.6%	2.2%
Taipei veterans general hospital^92,93	2004	D1: 110	7.3%	0%	53.6%	Survival;
		D3: 111	17.1%	0%	59.5%	D3＞D1
Japanese clinical oncology group^94-96	2005	D2: 263	20.9%	0.9%	69.2%	AGC patients
		D4: 259	28.1%	0.9%	70.3%

D3, lymphadenectomy for level 1, 2 and 3; D4, D2 lymphadenectomy with paraaortic lymph node disseciton.

TOOLS

Similar articles