title: Changing Trends in Gastric Cancer Surgery.
abstract: Gastric cancer is one of the most common causes of cancer-related death. It requires multimodal treatment and surgery is the most effective treatment modality. Radical surgery includes total or subtotal gastrectomy with lymph node dissection. The extent of lymphadenectomy still remains controversial. Eastern surgeons have performed D2 or more extended lymphadenectomy while their Western colleagues have performed more limited lymph node dissection. However, the trend has been changing in favour of D2 lymph node dissection in both hemispheres. Currently, D2 is the recommended type of lymphadenectomy in experienced centres in the west. In Japan, D2 lymph node dissection is the standard surgical approach. More extensive lymphadenectomy than D2 has not been found to be associated with improved survival and generally is not performed. Bursectomy and splenectomy are additional controversial issues in surgical performance, and trends regarding them will be discussed. The performance of bursectomy is controversial and there is no clear evidence of its clinical benefit. However, a trend toward better survival in patients with serosal invasion has been reported. Routine splenectomy as a part of lymph node dissection has largely been abandoned, although splenectomy is recommended in selected cases. Minimally invasive surgery has gained wide popularity and indications for minimally invasive procedures have been expanding due to increasing experience and improving technology. Neoadjuvant therapy has been shown to have beneficial effects and seems necessary to provide a survival benefit. Diagnostic laparoscopy should be kept in mind prior to treatment.
authors.affiliation: Department of Gastroenterological Surgery, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: İlter
authors.initials: İ
authors.lastname: Özer
authors.affiliation: Department of Gastroenterological Surgery, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: Erdal Birol
authors.initials: EB
authors.lastname: Bostancı
authors.affiliation: Department of Gastroenterological Surgery, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Ulaş
authors.affiliation: Department of Gastroenterological Surgery, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Özoğul
authors.affiliation: Department of Gastroenterological Surgery, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: Musa
authors.initials: M
authors.lastname: Akoğlu
mesh_terms: D002061:Bursa, Synovial / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000639:trends*; D004724:Endoscopy / Q000379:methods / Q000639:trends; D005743:Gastrectomy / Q000379:methods / Q000639:trends; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000639:trends; D008197:Lymph Node Excision / Q000379:methods / Q000639:trends; D065287:Robotic Surgical Procedures / Q000379:methods; D013156:Splenectomy / Q000379:methods / Q000639:trends; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Gastric cancer; bursectomy; lymph node dissection; minimally invasive surgery; splenectomy