Evolution of gastric surgery techniques and outcomes

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Clinical Trials

Background:

• Surgical management is key for gastric cancer survival.
• Debate exists regarding optimal gastrectomy extent and lymph node dissection (D1 vs. D2).

Purpose of the Study:

• To review evolving surgical techniques for gastric cancer.
• To discuss pivotal clinical trials informing current best practices.

Main Methods:

• Analysis of clinical trials comparing different lymph node dissection strategies (D1, D2, para-aortic).
• Evaluation of historical and current gastrectomy procedures (e.g., pancreatectomy, splenectomy, bursectomy).
• Assessment of laparoscopic gastrectomy feasibility and safety.

Main Results:

• D2 lymph node dissection shows superior long-term survival compared to D1, despite higher initial morbidity.
• Para-aortic lymph node dissection offers no additional survival benefit when combined with D2 dissection.
• Pancreas-preserving total gastrectomy with D2 dissection is now standard; splenectomy's role is under investigation.

Conclusions:

• Surgical approaches for gastric cancer have progressed towards optimizing survival and quality of life.
• Evidence supports D2 lymph node dissection and pancreas-preserving techniques.
• Laparoscopic gastrectomy is a feasible and safe option.