Current concepts in gastric cancer surgery.

Area of Science:

• Surgical Oncology
• Gastroenterology
• Clinical Medicine

Background:

• Gastric cancer surgery faces challenges in determining resection extent, lymphadenectomy degree, and preoperative staging.
• Optimizing surgical strategies is crucial for improving patient outcomes and quality of life.

Purpose of the Study:

• To evaluate the optimal surgical approach for gastric cancer based on tumor characteristics and patient outcomes.
• To identify factors influencing postoperative complications, mortality, and survival rates in gastric cancer patients.

Main Methods:

• Retrospective analysis of 284 gastric cancer patients undergoing surgery between 1987 and 1996.
• Data collected included epidemiological parameters, surgical procedures, histopathology, complications, mortality, and survival.
• Statistical analyses included Chi-square and Mann Whitney U tests, with survival calculated using the Kaplan-Meier method.

Main Results:

• Subtotal gastrectomy is favored for distal/middle gastric cancers with adequate margins (5cm intestinal, 10cm diffuse Lauren's type), offering lower risks and better quality of life.
• Resection of adjacent organs is reserved for direct tumor invasion (T4); extended lymphadenectomy is not indicated.
• Diagnostic laparoscopy is recommended for T3/T4 tumors or suspected spread due to high morbidity/mortality of exploratory laparotomy.

Conclusions:

• While gastric cancer surgery is standardized, a tailored approach based on cancer extent is justified.
• Optimizing surgical techniques can improve outcomes and reduce complications in gastric cancer treatment.