[Differential surgical procedure in curative therapy of stomach carcinoma]

The principle of histology-and stage-oriented cancer treatment generally adopted in modern oncology is realizable and desirable also in surgery for stomach carcinoma. Instead of a single standard operation for all gastric carcinomas surgical procedure should be individualized. Curative local therapy as endoscopic polypectomy or mucosal resection or laparoscopic intraluminal surgery is possible only in a limited number of patients. In all other patients radical resection is indicated, either as subtotal distal gastrectomy or as total gastrectomy, if necessary with extension to adjacent organs. The radical resection includes a radical lymphadenectomy (D2 dissection). Its extent should be adapted to the individual situation by consideration at least of tumor site. Preferable is the use of a pretherapeutic computer model which calculates the probability of metastasis to the various lymph node groups considering additional factors with influence on lymphatic spread.