Recent trends from the results of clinical trials on gastric cancer surgery

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Clinical Trials

Background:

• Gastric cancer treatment has evolved with large-scale clinical trials informing surgical strategies.
• Previous recommendations included D3 lymphadenectomy and specific surgical approaches for esophago-gastric junction tumors.

Purpose of the Study:

• To evaluate the efficacy and impact of specific surgical techniques in resectable gastric cancer.
• To determine if aggressive surgical procedures improve survival outcomes or increase morbidity.

Main Methods:

• Analysis of findings from large-scale clinical trials conducted by the Japan Clinical Oncology Group.
• Comparison of D2 versus D3 lymphadenectomy outcomes.
• Evaluation of transhiatal versus left thoraco-abdominal approaches.
• Assessment of splenectomy and bursectomy in conjunction with gastrectomy and D2 lymphadenectomy.

Main Results:

• D3 lymphadenectomy does not improve survival rates compared to D2 lymphadenectomy for resectable gastric cancer.
• A transhiatal approach is recommended over a left thoraco-abdominal approach for specific esophago-gastric junction adenocarcinomas.
• Splenectomy and bursectomy, when performed with D2 lymphadenectomy, do not improve survival and increase operative morbidity.

Conclusions:

• Surgical strategies for gastric cancer are shifting towards less invasive and more conservative approaches.
• Avoidance of D3 lymphadenectomy, splenectomy, and bursectomy may be beneficial in resectable gastric cancer surgery.
• Current evidence suggests that aggressive surgical interventions do not provide adequate survival benefits and may increase patient risk.