Individualized Surgery for Gastric Cancer

Kyung Won Seo; Ki Young Yoon

doi:10.4166/kjg.2011.57.6.335

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Seo and Yoon: Individualized Surgery for Gastric Cancer

Review Article

Korean J Gastroenterol 2011;57(6):335-339.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.57.6.335

Individualized Surgery for Gastric Cancer

Kyung Won Seo, Ki Young Yoon

Department of Surgery, Kosin University College of Medicine, Busan, Korea

Correspondence to: Ki Young Yoon, Department of Surgery, Kosin University College of Medicine, 34, Amnam-dong, Seo-gu, Busan 602-703, Korea. Tel: +82-51-990-6462, Fax: +82-51-246-6093, E-mail: yoonkiyoung@naver.com

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Recently, tailored and multidisciplinary treatment of gastric cancer was emerging in the field of clinical oncology. Gastric cancer is the most frequently diagnosed cancer in Korea. Surgery is the only possible curative procedure, and extensive gastrectomy and D2 lymph node dissection has been accepted as standard treatment in all gastric cancer patients until recently. In early gastric cancer, many researchers established the indications of limited surgery including endoscopic mucosal resection based on various well-collected retrospective data. Limited surgery and minimally invasive surgery contribute to quality of life in gastric cancer patients. In advanced gastric cancer, eastern surgeons believe that D2 lymph node dissection is standard treatment if done by credential surgeons in specialized centers despite of different opinion of western surgeon. In addition, adjuvant chemotherapy after good local control by D2 dissection has gained survival benefit rather than D2 dissection alone in randomized trials. In conclusion, present confronted issue is to establish tailored treatments of individualized patients through extent of disease in gastric cancer patients.

Keywords: Gastric neoplasm, Gastrectomy, Lymph node dissection, Tailored treatment

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Table 1.

Prospective Randomized Controlled Trials about Comparison of D1 and D2

Study	Period	No. of participant	Extent of LN	No. of	Morbidity	Mortality	5YSR
Study	Period	surgeon	dissection	patients	(%)	(%)	(%)
Cuschieri (MRC trial)	1987-1994	32	D1	200	28	6.5	435
			D2	200	46	13	33
Bonenkamp (Dutch trial)	1989-1993	80	D1	380	25	4	45
			D2	331	43	10	47
Wu (Taipei)	1993-1999	3	D1	110	7	0	53.6
			D3 (D2)	111	17	0	59.5

LN, lymph node; YSR, year survival rate; MRC, medical research council.

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