title: Extent of lymphadenectomy and perioperative therapies: two open issues in gastric cancer.
abstract: Gastric cancer is one of the leading causes of death for cancer worldwide, although geographical variations in incidence exist. Over the last decades, its incidence and mortality have gradually decreased in Western countries, while these have increased, or remained stable, in the other world regions. Gastric cancer is often diagnosed at an advanced stage, with the only notable exception of Japan, where nationwide screening programs are enforced, due to local high incidence. Curative- intent surgery (i.e., gastrectomy, total or partial, and lymphadenectomy) remains the cornerstone of treatment of gastric cancer. Much has been debated about the extent of lymph node dissection and, although it is a valuable contribution to staging and cure, operative treatment only represents one aspect of overall effective management, as the risk of both locoregional and distant recurrences are high, and bear a poor prognosis. As a matter of fact, surgery, as a single modality treatment, has probably achieved its maximum efficacy for local control and survival, while other accompanying nonsurgical treatment modalities have to be taken into account, although their role is still the subject of considerable debate. The authors in this review present an update on the outcome of treatment of gastric cancer in relation to the extent of lymphadenectomy and of various nonsurgical preoperative, intraoperative, and postoperative strategies.
authors.affiliation: Andrea Giuliani, Michelangelo Miccini, Luigi Basso, Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Medical School, Policlinico "Umberto I", 00161 Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Giuliani
authors.affiliation: Andrea Giuliani, Michelangelo Miccini, Luigi Basso, Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Medical School, Policlinico "Umberto I", 00161 Rome, Italy.
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Miccini
authors.affiliation: Andrea Giuliani, Michelangelo Miccini, Luigi Basso, Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Medical School, Policlinico "Umberto I", 00161 Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Basso
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D005743:Gastrectomy; D006801:Humans; D007263:Infusions, Parenteral; D007564:Japan; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D059035:Perioperative Period; D011184:Postoperative Period; D057234:Preoperative Period; D011878:Radiotherapy; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000601:surgery*
chemical_list: D000970:Antineoplastic Agents
keywords: Adenocarcinoma; Chemoradiotherapy; Chemotherapy; Gastric cancer; Intraperitoneal; Meta-analysis; Postoperative; Preoperative; Radiotherapy; Randomized controlled trial
references.citation: Br J Surg. 2005 Jan;92(1):5-13
references.pmid: 15635680
references.citation: Cancer. 2000 Apr 15;88(8):1796-800
references.pmid: 10760754
references.citation: Hepatogastroenterology. 1999 Jan-Feb;46(25):549-54
references.pmid: 10228860
references.citation: Int J Clin Oncol. 2008 Apr;13(2):132-7
references.pmid: 18463957
references.citation: World J Surg. 1987 Aug;11(4):418-25
references.pmid: 3630186
references.citation: Int J Radiat Oncol Biol Phys. 1982 Jan;8(1):1-11
references.pmid: 7061243
references.citation: Ann Surg. 2011 May;253(5):900-11
references.pmid: 21394009
references.citation: Semin Surg Oncol. 2003;21(4):233-48
references.pmid: 14648781
references.citation: Radiother Oncol. 2009 Aug;92(2):176-83
references.pmid: 19586672
references.citation: Br J Surg. 2005 Sep;92(9):1103-9
references.pmid: 16106493
references.citation: Ann Surg Oncol. 2000 Apr;7(3):210-7
references.pmid: 10791852
references.citation: Eur J Surg Oncol. 2008 Nov;34(11):1208-16
references.pmid: 18353606
references.citation: J Surg Oncol. 2002 Jun;80(2):72-8
references.pmid: 12173383
references.citation: Int J Radiat Oncol Biol Phys. 2005 Dec 1;63(5):1279-85
references.pmid: 16099596
references.citation: Br J Surg. 2010 May;97(5):643-9
references.pmid: 20186890
references.citation: Lancet Oncol. 2009 Feb;10(2):191-5
references.pmid: 19185837
references.citation: Lancet. 1995 Mar 25;345(8952):745-8
references.pmid: 7891484
references.citation: Lancet Oncol. 2010 May;11(5):439-49
references.pmid: 20409751
references.citation: Gastric Cancer. 2012 Sep;15 Suppl 1:S60-9
references.pmid: 22138927
references.citation: J Chemother. 2006 Jun;18(3):311-7
references.pmid: 17129844
references.citation: J Natl Cancer Inst. 1993 Nov 17;85(22):1839-44
references.pmid: 8230264
references.citation: Eur J Surg Oncol. 2004 Aug;30(6):643-9
references.pmid: 15256239
references.citation: Int J Radiat Oncol Biol Phys. 1998 Dec 1;42(5):929-34
references.pmid: 9869212
references.citation: Gastric Cancer. 1998 Dec;1(1):25-30
references.pmid: 11957041
references.citation: BMC Cancer. 2011 Aug 02;11:329
references.pmid: 21810227
references.citation: World J Gastroenterol. 2010 Feb 21;16(7):868-74
references.pmid: 20143466
references.citation: Am J Surg. 2003 Jul;186(1):23-7
references.pmid: 12842743
references.citation: N Engl J Med. 2007 Nov 1;357(18):1810-20
references.pmid: 17978289
references.citation: J Clin Oncol. 1984 Nov;2(11):1249-54
references.pmid: 6491703
references.citation: Lancet. 1999 Jul 24;354(9175):273-7
references.pmid: 10440302
references.citation: Ann Surg Oncol. 2000 Mar;7(2):139-44
references.pmid: 10761793
references.citation: Ann Surg Oncol. 2007 Oct;14(10):2702-13
references.pmid: 17653801
references.citation: J Natl Compr Canc Netw. 2013 May 1;11(5):531-46
references.pmid: 23667204
references.citation: J Clin Oncol. 2010 Dec 10;28(35):5210-8
references.pmid: 21060024
references.citation: Cochrane Database Syst Rev. 2012 Jan 18;1:CD001964
references.pmid: 22258947
references.citation: World J Surg. 1994 Jan-Feb;18(1):150-5
references.pmid: 8197772
references.citation: Cancer Treat Rev. 2007 Dec;33(8):729-40
references.pmid: 17935888
references.citation: Br J Surg. 1988 Feb;75(2):110-2
references.pmid: 3349293
references.citation: Br J Surg. 2007 Dec;94(12):1468-76
references.pmid: 17948223
references.citation: J Clin Oncol. 2011 May 1;29(13):1715-21
references.pmid: 21444866
references.citation: J Am Coll Surg. 1995 Jul;181(1):26-32
references.pmid: 7599767
references.citation: J Clin Oncol. 2012 Jan 20;30(3):268-73
references.pmid: 22184384
references.citation: J Clin Oncol. 2012 Jul 1;30(19):2327-33
references.pmid: 22585691
references.citation: Lancet. 1996 Apr 13;347(9007):995-9
references.pmid: 8606613
references.citation: World J Surg. 2005 Dec;29(12):1576-84
references.pmid: 16317484
references.citation: J Clin Oncol. 1998 Aug;16(8):2733-8
references.pmid: 9704725
references.citation: Lancet. 1994 May 28;343(8909):1309-12
references.pmid: 7910321
references.citation: J Clin Oncol. 2004 Jul 15;22(14):2767-73
references.pmid: 15199090
references.citation: N Engl J Med. 1999 Mar 25;340(12):908-14
references.pmid: 10089184
references.citation: N Engl J Med. 2008 Jul 31;359(5):453-62
references.pmid: 18669424
references.citation: Gastric Cancer. 2012 Sep;15 Suppl 1:S70-88
references.pmid: 22895615
references.citation: N Engl J Med. 2001 Sep 6;345(10):725-30
references.pmid: 11547741
references.citation: J Clin Oncol. 2011 Nov 20;29(33):4387-93
references.pmid: 22010012
references.citation: Curr Probl Cancer. 2011 May-Jun;35(3):97-127
references.pmid: 21635986
references.citation: J Clin Oncol. 2004 Jun 1;22(11):2069-77
references.pmid: 15082726
references.citation: Int J Radiat Oncol Biol Phys. 1990 Dec;19(6):1357-62
references.pmid: 2262358
references.citation: N Engl J Med. 2006 Jul 6;355(1):11-20
references.pmid: 16822992
references.citation: Br J Surg. 2009 Jan;96(1):26-33
references.pmid: 19016271
references.citation: J Clin Oncol. 2010 May 10;28(14):2430-6
references.pmid: 20368551
references.citation: Eur J Surg Oncol. 2000 Dec;26(8):773-9
references.pmid: 11087644
references.citation: Cancer. 1999 Feb 1;85(3):529-34
references.pmid: 10091726
references.citation: Eur J Surg Oncol. 2005 Oct;31(8):875-81
references.pmid: 16051460
references.citation: Lancet. 2012 Jan 28;379(9813):315-21
references.pmid: 22226517
references.citation: Br J Surg. 1993 Aug;80(8):1015-8
references.pmid: 8402053
references.citation: Ann Surg Oncol. 2002 May;9(4):401-5
references.pmid: 11986193
references.citation: Hepatogastroenterology. 2000 May-Jun;47(33):893-6
references.pmid: 10919056
references.citation: Ann Oncol. 2006 Feb;17(2):262-9
references.pmid: 16293676
references.citation: Lancet Oncol. 2006 Apr;7(4):309-15
references.pmid: 16574546
references.citation: Therap Adv Gastroenterol. 2012 Jan;5(1):49-69
references.pmid: 22282708
references.citation: JAMA. 2010 May 5;303(17):1729-37
references.pmid: 20442389
references.citation: World J Surg. 2001 Aug;25(8):985-90
references.pmid: 11571980
references.citation: Jpn J Surg. 1981 Mar;11(2):127-39
references.pmid: 7300058
references.citation: Br J Surg. 2004 Mar;91(3):283-7
references.pmid: 14991627
references.citation: Am J Surg. 2009 Feb;197(2):246-51
references.pmid: 18722583
references.citation: Gastric Cancer. 1998 Dec;1(1):10-24
references.pmid: 11957040
references.citation: Br J Cancer. 1999 Mar;79(9-10):1522-30
references.pmid: 10188901
references.citation: Br J Cancer. 1989 Nov;60(5):739-44
references.pmid: 2508737