[Surgery of stomach carcinoma--established and controversial procedures. Retrospective 1-year analysis with discussion of current aspects].
BACKGROUND
Current problems in gastric cancer surgery concern the extent of gastric resection, the need for abdominal evisceration, the degree of lymphadenectomy, and optimal preoperative tumor staging procedure.


METHODS
In a restrospective analysis, data on epidemiology, extent of surgery, histopathology, postoperative complications, mortality, and survival in 284 gastric cancer patients were evaluated.


RESULTS
Our results are in favor of subtotal gastrectomy performed for all T stages located in the distal or middle third, provided that a tumor-free margin of 5 cm in intestinal type and 10 cm in diffuse Lauren's type tumor can be achieved. Additional organ resections are indicated only if direct tumor invasion has occurred, and should not be part of an extended lymphadenectomy procedure. The degree of lymph node removal should be guided by the primary tumor site. Multimodal therapeutic approaches and high postoperative mortality after exploratory laparotomy justify the use of diagnostic laparoscopy in T3/4 tumors and if diagnostic scans suggest possible tumor spread.


CONCLUSIONS
Even though surgery for gastric cancer is well standardized, a tailored surgical approach to different extent of gastric cancer appears warranted.
Schumacher
I K
IK
Chirurgische Klinik, Ernst Moritz Arndt-Universität Greifswald.
Hunsicker
A
A
Petermann
J
J
Lorenz
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate