[Limited or extensive surgery in gastric carcinoma?]

Although the incidence of gastric cancer has dropped it is still the most frequent carcinoma of dhe digestive tract. Surgical management of gastric carcinoma was always dependent on the stage of the disease. Contemporary knowledge of gastric lymph drainage and attempts to remove metastatic glands with the tumor gave rise to more optimism. In the beginning such and approach did not fulfill expectations, but during the past decades, especially in Japan, it became evident that more aggressive and extensive surgical procedures could benefit certain groups of patients. In order to asses this new approach it is necessary to have a unique TNM classification and to perform a rigorous and systematic identification of cancer metastasis in the lymph nodal system of the stomach. Comparison of partial gastric resection with limited standard lymphadenectomy to total gastrectomy with extensive lymphadenectomy is not possible. Nevertheless, patients with gastric cancer stages Ib, II and IIIa profit from more extensive surgery. The author present the modifications in the extent of surgical procedures for the management of gastric cancer. Special emphasis is drawn to the surgical technique and results of systemic extensive lymphadenectomy. The author has demonstrated the benefits of the new extensive surgical approach in he management of gastric cancer in his series. Operative mortality in the group of patients after systemic lymphadenectomy was 6.7% and the 5-year survival rate was 21.0%. In the group of patients where gastric resection with standard lymphadenectomy was performed postoperative mortality was 14.0% and the 5-year survival was only 5.3%.