Optimal surgery for advanced gastric cancer

Area of Science:

• Surgical Oncology
• Gastrointestinal Oncology

Background:

• Locoregional control is a significant challenge in gastric cancer surgery, despite curative resection being the primary treatment.
• The optimal extent of lymph node dissection in gastric cancer remains a subject of debate.

Purpose of the Study:

• To evaluate the survival benefit and morbidity associated with pancreas and spleen-preserving D2 lymphadenectomy in gastric cancer surgery.
• To determine the necessity of splenectomy in gastric cancer resection.

Main Methods:

• Review of surgical techniques and outcomes for gastric cancer, focusing on lymphadenectomy extent.
• Analysis of the impact of splenectomy on morbidity and mortality.
• Assessment of predictive tools like the Maruyama Index and nomograms for patient selection.

Main Results:

• Pancreas and spleen-preserving D2 lymphadenectomy provides superior staging and potential survival benefits with acceptable morbidity.
• Splenectomy increases morbidity and mortality without improving survival unless there is direct tumor invasion.
• Predictive models can aid in identifying high-risk patients for tailored treatments.

Conclusions:

• Pancreas and spleen-preserving D2 lymphadenectomy is recommended for gastric cancer surgery.
• Splenectomy should be avoided in gastric cancer resection unless necessitated by direct tumor invasion.
• High-volume centers and experienced surgeons are crucial for optimal gastric cancer surgical outcomes.