[Recent progress in the curative surgical treatment of stomach cancer].
Surgical resection is currently the only potentially curative treatment for gastric cancer. Nodal extension, present in 3/4 of the patients, is related to topography and penetration of the tumor and is progressive, beginning by the perigastric proximal lymph nodes N1 to the perivascular distal nodes N2. A subtotal gastrectomy is possible for distal cancers and total gastrectomy is necessary for cancers of the middle and upper portions. D1 lymphadenectomy is the resection of the N1 perigastric nodes (> 15) and D2 lymphadenectomy is the resection fo the N2 perivascular nodes (> 25). In Japan, 5 year survival after D2 resection is very high, around 60%, but all the series are retrospective with a high proportion of superficial cancers. In several recent European controlled studies, D2 resection is responsible for a high mortality rate (> 10%) and the reported 45% survival is not statistically different from the D1 resection. In Western patients an "in-between" lymphadenectomy without spleno-pancreatectomy can be recommended with analysis of at least 15 nodes, and with a mortality lower than 5%. Pathological analysis of the operative specimen allows to use the new TNM classification where the number of positive lymph nodes is the main independent prognostic factor.
Gouzi
J L
JL
Service de Chirurgie Générale et Digestive, CHU Purpan, Toulouse.
Pradère
B
B
Bloom
E
E
Julio
C
C
Seulin
P
P
Carrère
N
N
D000368:Aged; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D013997:Time Factors