Surgical Management of Gastric Cancer: A Systematic Review

Abstract

Gastric cancer is the fifth most common cancer worldwide, and it is responsible for 7.7% of all cancer deaths. Despite advances in the field of oncology, where radiotherapy, neo and adjuvant chemotherapy may improve the outcome, the only treatment with curative intent is represented by surgery as part of a multimodal therapy. Two concepts may be adopted in appropriate cases, neoadjuvant treatment before gastrectomy (G) or primary surgical resection followed by chemotherapy. Such an approach, combined with early detection and better screening, has led to a decrease in the overall incidence of gastric cancer. Unfortunately, malignant tumors of the stomach are often diagnosed in locally advanced or metastatic stages when the median overall survival remains poor. Surgical care in these cases must be provided by a multidisciplinary team in a high-volume center. Important surgical aspects such as optimum resection margins, surgical technique, and number of harvested lymph nodes are important factors for patient outcomes. The standardization of surgical treatment of gastric cancer in accordance with the patient's profile is of decisive importance for a better outcome. This review aims to summarize the current standards in the surgical treatment of gastric cancer.

Keywords: gastric cancer; lymphadenectomy; surgery; survival.

Figure 1

Treatment strategies of gastric cancer according to TNM stage. Stage 0: TisN0M0; stage IA: T1N0M0; stage IB: T2N0M0; stage II: T1N2M0/T2N1M0/T3N0M0; stage IIIA: T3N1M0/T4N0M0; stage IIIB: T3N2M0; stage IV: T3N1-3M0/T1-3N3M0/T1-4N0-3M1 (Tis—the mucosa; T1—submucosa;T2—muscle layer; T3—subserosa; T4—serosa/adjacent structures/N0—(0+)LN; N1—(1–2+)LN; N2—(3–6+)LN; N3—(>7+)LN/M0—no metastasis; M1—distant metastasis or carcinomatosis); LN—lymph nodes; ST—subtotal; T—total; ChT—chemotherapy; ChRxT—chemo-radiotherapy; preop—preoperative; postop—postoperative.