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Review
. 2019 Mar 27;39(1):11.
doi: 10.1186/s40880-019-0360-1.

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

Takashi Kiyokawa  1 , Takeo Fukagawa  2
Affiliations
Review

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

Takashi Kiyokawa et al. Cancer Commun (Lond). .

Abstract

The Japan Clinical Oncology Group has recently conducted large scale clinical trials with findings that have revealed pivotal strategies for the treatment of resectable gastric cancer surgery. These findings include the fact that D3 lymphadenectomy does not improve survival rates when compared to D2 lymphadenectomy, and it is not recommended for resectable gastric cancer. Also, a transhiatal approach is recommended, instead of the left thoraco-abdominal approach, for the treatment of adenocarcinoma of the esophago-gastric junction or gastric cardia which has invaded ≤ 3 cm of the esophagus. Gastrectomy with splenectomy and bursectomy had been recommended as a part of the D2 lymphadenectomy. However, the results of the recent clinical trials revealed that splenectomy should be avoided in total gastrectomy with D2 lymphadenectomy for proximal gastric cancer and that bursectomy should be avoided in gastrectomy with D2 lymphadenectomy for resectable gastric cancer. Both splenectomy and bursectomy were found to be unable to improve survival, but instead increased operative morbidity. These trials revealed that the above-mentioned invasive and aggressive procedures did not provide sufficient survival benefits and that gastric cancer surgery may be trending from an "invasive to less invasive" and "aggressive to more conservative" approach.

Keywords: Bursectomy; D2 lymphadenectomy; D3 lymphadenectomy; Gastric cancer; Hiatal approach; Japanese Gastric Cancer Association; Left thoraco-abdominal approach; Para-aortic lymph nodes; Randomized clinical trials; Splenectomy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Para-aortic lymph node dissection. Illustration of the para-aortic lymph node dissection of the caudal part of the left renal vein during D2 lymphadenectomy. LRV, left renal vein; LN No. 16, lymph nodes at station 16; LTV, left testicular vein
Fig. 2
Fig. 2
The left thoraco-abdominal approach. Illustration of the transection of the diaphragm for adenocarcinoma at/near the esophagogastric junction
Fig. 3
Fig. 3
Illustrations of bursectomy for advanced gastric cancer. a Dissecting the anterior layer of the transverse mesocolon. b Schema of the bursectomy. The red arrow represents the dissection line for bursectomy. 8a, lymph nodes at station 8a: A, common hepatic artery; V, splenic vein
See this image and copyright information in PMC

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