title: Improving the outcomes in gastric cancer surgery.
abstract: Gastric cancer remains a significant health problem worldwide and surgery is currently the only potentially curative treatment option. Gastric cancer surgery is generally considered to be high risk surgery and five-year survival rates are poor, therefore a continuous strive to improve outcomes for these patients is warranted. Fortunately, in the last decades several potential advances have been introduced that intervene at various stages of the treatment process. This review provides an overview of methods implemented in pre-, intra- and postoperative stage of gastric cancer surgery to improve outcome. Better preoperative risk assessment using comorbidity index (e.g., Charlson comorbidity index), assessment of nutritional status (e.g., short nutritional assessment questionnaire, nutritional risk screening - 2002) and frailty assessment (Groningen frailty indicator, Edmonton frail scale, Hopkins frailty) was introduced. Also preoperative optimization of patients using prehabilitation has future potential. Implementation of fast-track or enhanced recovery after surgery programs is showing promising results, although future studies have to determine what the exact optimal strategy is. Introduction of laparoscopic surgery has shown improvement of results as well as optimization of lymph node dissection. Hyperthermic intraperitoneal chemotherapy has not shown to be beneficial in peritoneal metastatic disease thus far. Advances in postoperative care include optimal timing of oral diet, which has been shown to reduce hospital stay. In general, hospital volume, i.e., centralization, and clinical audits might further improve the outcome in gastric cancer surgery. In conclusion, progress has been made in improving the surgical treatment of gastric cancer. However, gastric cancer treatment is high risk surgery and many areas for future research remain.
authors.affiliation: Juul JW Tegels, Michiel FG De Maat, Karel WE Hulsewé, Anton GM Hoofwijk, Jan HMB Stoot, Department of Surgery, Orbis Medical Center, 6130 MB Sittard, The Netherlands.
authors.forename: Juul J W
authors.initials: JJ
authors.lastname: Tegels
authors.affiliation: Juul JW Tegels, Michiel FG De Maat, Karel WE Hulsewé, Anton GM Hoofwijk, Jan HMB Stoot, Department of Surgery, Orbis Medical Center, 6130 MB Sittard, The Netherlands.
authors.forename: Michiel F G
authors.initials: MF
authors.lastname: De Maat
authors.affiliation: Juul JW Tegels, Michiel FG De Maat, Karel WE Hulsewé, Anton GM Hoofwijk, Jan HMB Stoot, Department of Surgery, Orbis Medical Center, 6130 MB Sittard, The Netherlands.
authors.forename: Karel W E
authors.initials: KW
authors.lastname: Hulsewé
authors.affiliation: Juul JW Tegels, Michiel FG De Maat, Karel WE Hulsewé, Anton GM Hoofwijk, Jan HMB Stoot, Department of Surgery, Orbis Medical Center, 6130 MB Sittard, The Netherlands.
authors.forename: Anton G M
authors.initials: AG
authors.lastname: Hoofwijk
authors.affiliation: Juul JW Tegels, Michiel FG De Maat, Karel WE Hulsewé, Anton GM Hoofwijk, Jan HMB Stoot, Department of Surgery, Orbis Medical Center, 6130 MB Sittard, The Netherlands.
authors.forename: Jan H M B
authors.initials: JH
authors.lastname: Stoot
mesh_terms: D015897:Comorbidity; D003661:Decision Support Techniques; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D006304:Health Status; D006801:Humans; D010535:Laparoscopy; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D019990:Perioperative Care; D011237:Predictive Value of Tests; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Gastric cancer; Laparoscopic surgery; Postoperative care; Risk assessment; Surgical outcome