[The treatment of patients with gastric carcinoma based on the results of Dutch studies].
--The extent of lymph-node dissection in gastrectomy for gastric carcinoma and the use of adjuvant or neo-adjuvant chemotherapy is a matter still under discussion. Only radical resection can offer a cure. --Non-randomised studies show that extended lymph-node dissections are more advantageous than less extended dissections. None of the randomised trials confirms this. The associated statistically significant higher morbidity and mortality offsets its long-term advantageous effect on survival. --If procedures that increase morbidity and mortality such as pancreatectomy and splenectomy can be avoided, then extended lymph-node dissections are more advantageous. --In cases of inadequate dissection (i.e. less than 15 lymph nodes removed) adjuvant radiochemotherapy confers an advantage. If adequate dissection is carried out, this advantage is not present. --To date there is no indication for adjuvant or neo-adjuvant chemotherapy. --To improve the results of treatment for gastric carcinoma in Western countries and to simplify trial participation, treatment for patients with gastric carcinoma should be centralised.
Hartgrink
H H
HH
Leids UniversitairMedisch Centrum, afd. Heelkunde, K6-50, Postbus 9600, 2300 RC Leiden. h.h.hartgrink@lumc.nl
van de Velde
C J H
CJ
D002277:Carcinoma / Q000401:mortality / Q000601:surgery*; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D009426:Netherlands / Q000453:epidemiology; D010180:Pancreatectomy; D013156:Splenectomy; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis