Ten Thousand Consecutive Gastrectomies for Gastric Cancer: Perspectives of a Master Surgeon

Abstract

As radical gastrectomy with lymph node dissection is currently the best strategy to cure gastric cancer, the role of the surgeon remains quite important in conquering it. Dr. Sung Hoon Noh, a surgeon and surgical oncologist specializing in gastric cancer, has treated gastric cancer for 30 years and has conducted over 10000 cases of gastrectomy for gastric cancer. He first adapted an electrocautery device into gastric cancer surgery and has led standardization of surgical procedures, including spleen preserving gastrectomy. His procedures based on patient-oriented insights have become the basis of the concept of enhanced recovery after surgery. He has also contributed to improving patient's survival through adoption of a multidisciplinary approach: he proved the benefit of adjuvant chemotherapy after radical D2 gastrectomy for stage II/III gastric cancer in clinical trials, updating treatment guidelines throughout the world. Dr. Noh also opened the era of precision medicine for treating gastric cancer, as he developed and validated a mRNA expression based algorithm to predict prognosis and response to chemotherapy. This article reviews his contribution and long history of service in the field of gastric cancer. The perspectives of this master surgeon, based on his profound experience and insights, will outline directions for integrative multidisciplinary health care and how can surgeons prepare for the future.

Keywords: Gastric cancer; chemotherapy; perspective; precision medicine; surgery.

Fig. 1. Annual number of gastrectomy cases performed by Dr. Noh. STG, subtotal gastrectomy; TG, total gastrectomy including completion total gastrectomy.

Fig. 2. Changes in overall survival for patients with gastric cancer treated at Yonsei Gastric Cancer Center according to stage (AJCC 7th) and time. AJCC, American Joint Committee on Cancer.