[Determination of surgical status: stomach cancer]

In spite of a decrease in the frequency of gastric carcinoma as shown in some statistics this malignoma still is an almost daily challenge in surgery. The prognosis of the gastric cancer, in general, depends upon the time of onset of therapy and the tumor grading. At present, chemotherapy and radiation therapy cannot be regarded as alternatives to surgical therapy. An improvement in the preoperative diagnostic procedures including the use of CT has not altered the prognosis of the gastric carcinoma. The procedure of choice in the treatment of gastric cancer should be total gastrectomy. The only exception to this rule is the small antrum carcinoma of the intestinal type, in which subtotal resection seems sufficient. This should comprise a 4/5-resection of the stomach and should be carried out with the same radicality concerning lymphadenectomy in the extragastric region as in total gastrectomy. The problem of intraluminal recurrency is declining provided that sufficient safety distances are maintained. An additive Brachy-radiation type therapy with intraoperative application of 125Jodine-seeds into remaining metastatic lymph-nodes seem to be a new approach to improve the prognosis of the palliatively resected gastric carcinoma. In our experience esophago-jejunoplication for reestablishment of passage following gastrectomy serves best the demand for creating a food reservoir and in preventing intestino-esophageal reflux. It seems to be of prime importance to prepare the patient psychologically for the loss of the stomach and to endow him with dietary plans for the food intake later on.