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. 2017 Oct;24(5):324-331.
doi: 10.3747/co.24.3736. Epub 2017 Oct 25.

Staging and surgical approaches in gastric cancer: a clinical practice guideline

N Coburn  1 , R Cosby  2 , L Klein  3 , G Knight  4 , R Malthaner  5 , J Mamazza  6 , C D Mercer  7 , J Ringash  8
Affiliations

Staging and surgical approaches in gastric cancer: a clinical practice guideline

N Coburn et al. Curr Oncol. 2017 Oct.

Abstract

Background: Resection is the cornerstone of cure for gastric adenocarcinoma; however, several aspects of surgical intervention remain controversial or are suboptimally applied at a population level, including staging, extent of lymphadenectomy (lnd), minimum number of lymph nodes that have to be assessed, gross resection margins, use of minimally invasive surgery, and relationship of surgical volumes with patient outcomes and resection in stage iv gastric cancer.

Methods: Literature searches were conducted in databases including medline (up to 10 June 2016), embase (up to week 24 of 2016), the Cochrane Library and various other practice guideline sites and guideline developer Web sites. A practice guideline was developed.

Results: One guideline, seven systematic reviews, and forty-eight primary studies were included in the evidence base for this guidance document. Seven recommendations are presented.

Conclusions: All patients should be discussed at a multidisciplinary team meeting, and computed tomography (ct) imaging of chest and abdomen should always be performed when staging patients. Diagnostic laparoscopy is useful in the determination of M1 disease not visible on ct images. A D2 lnd is preferred for curative-intent resection of gastric cancer. At least 16 lymph nodes should be assessed for adequate staging of curative-resected gastric cancer. Gastric cancer surgery should aim to achieve an R0 resection margin. In the metastatic setting, surgery should be considered only for palliation of symptoms. Patients should be referred to higher-volume centres and those that have adequate support to manage potential complications. Laparoscopic resections should be performed to the same standards as those for open resections, by surgeons who are experienced in both advanced laparoscopic surgery and gastric cancer management.

Keywords: Gastric cancer; laparoscopic surgery; lymph node dissection; practice guidelines; staging; surgery; surgical margins; surgical volumes.

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References

    1. World Health Organization, International Agency for Research on Cancer (iarc) globocan 2012. Stomach Cancer: Estimated Incidence, Mortality and Prevalence Worldwide in 2012 [Web page] Lyon, France: IARC; 2012. [Available at: http://globocan.iarc.fr/old/FactSheets/cancers/stomach-new.asp; cited 29 May 2015]
    1. Canadian Cancer Society’s Advisory Committee on Cancer Statistics . Canadian Cancer Statistics 2016. Toronto, ON: Canadian Cancer Society; 2016.
    1. Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (esge) guideline. Endoscopy. 2015;47:829–54. doi: 10.1055/s-0034-1392882. - DOI - PubMed
    1. Coburn NG, Lourenco LG, Rossi SE, et al. Management of gastric cancer in Ontario. J Surg Oncol. 2010;102:54–63. doi: 10.1002/jso.21561. - DOI - PubMed
    1. Karanicolas PJ, Elkin EB, Jacks LM, et al. Staging laparoscopy in the management of gastric cancer: a population-based analysis. J Am Coll Surg. 2011;213:644–51. doi: 10.1016/j.jamcollsurg.2011.07.018. ,51.e1. - DOI - PubMed

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