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Redefining surgery for gastric cancer.

J. L. Whiting1, M. T. Hallissey, D. C. Rowlands

  • 1Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2TH, UK.

Gastric Cancer : Official Journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association
|April 17, 2002
PubMed
Summary

Reclassifying gastric cancer "N" staging may guide surgeons to perform less invasive procedures. This approach aims to reduce mortality associated with extensive D2 resections while ensuring curative surgery for patients with N2 node involvement.

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Area of Science:

  • Surgical Oncology
  • Gastrointestinal Surgery
  • Cancer Staging

Background:

  • Retrospective studies suggested benefits of D2 resections for gastric cancer.
  • However, two large randomized trials revealed doubled mortality with D2 resections versus D1, without improving long-term survival.
  • D2 resection remains crucial for curative intent in cases of N2 node involvement.

Purpose of the Study:

  • To propose a reclassification of the International Union Against Cancer TNM "N" staging system for gastric cancer.
  • To introduce an anatomical basis for staging to better define surgical procedures.
  • To utilize junctional nodes as surgical guides to tailor resection extent.

Main Methods:

  • Review of existing TNM staging for gastric cancer.

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  • Proposal for a revised staging system incorporating anatomical landmarks.
  • Identification of junctional nodes between N1 and N2 tiers to guide surgical decisions.

    • Main Results:

    • The proposed reclassification aims to identify patients who may not require extensive D2 resections.
    • Uninvolved junctional nodes suggest a low probability of gastric bed (N2) involvement, potentially avoiding radical D2 dissection.
    • This targeted approach could reduce the morbidity and mortality associated with D2 resections.

    Conclusions:

    • "Stage-appropriate" surgery based on revised staging can decrease the number of D2 resections performed.
    • Patients with N2 disease will still receive necessary curative surgery.
    • A prospective, randomized, controlled trial is needed to validate the efficacy of this targeted surgical approach.