Radical Gastrectomy: Still the Gold Standard Treatment for Gastric Cancer—Our Experience from a Tertiary Care Center from Northeast India

  • Joydeep Purkayastha
  • Jitin YadavEmail author
  • Abhijit Talukdar
  • Gaurav Das
  • Niju Pegu
  • Srishti Madhav
  • Pritesh R. Singh
  • Vinay Mamidala
Original Article


Gastric cancer (GC) is common in the northeast and southern parts of India. Radical surgery is the cornerstone of treatment and offers the only chance for cure. This study was conducted to assess the outcomes of all resectable gastric cancers that presented to our tertiary cancer center in Northeast India. All patients undergoing upfront surgery for gastric cancer with curative intention between 2012 and 2017 were included in the study. A total of 116 patients who underwent upfront radical gastrectomy were included in the study. Males (58.6%) were more common than females (41.4%). Mean age at presentation was 56.12 years (range 26–89). The most common mode of presentation was pain abdomen (53.8%). The most common location of tumor was the distal part (81%) followed by the proximal part (10.3%). The most commonly done procedure was distal radical gastrectomy (56.9%) followed by subtotal gastrectomy (32.8%). Median number of lymph nodes isolated was 14. Fifty-four patients received adjuvant chemotherapy while 32 patients received adjuvant chemoradiation (CTRT). At a median follow-up of 14 months (range, 2–78 months), overall 5-year survival was 23.75% (mean survival 33.77 months, median survival 24 months). The 5-year survival for stages I–III was 100%, 26.25%, and 11.25%, respectively (P < 0.001). Though perioperative chemotherapy has a role in gastric cancer, it is not the substitute for radical D2 gastrectomy which is still the gold standard treatment especially in high-volume centers.


MAGIC trial D2 lymph node dissection Perioperative chemotherapy ACCORD 07 trial Gastrectomy 



  1. 1.
    Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68(1):7–30CrossRefGoogle Scholar
  2. 2.
    Dikshit RP, Mathur G, Mhatre S, Yeole BB (2011) Epidemiological review of gastric cancer in India. Indian J Med Paediatr Oncol 32:3–11CrossRefGoogle Scholar
  3. 3.
    Sharma A, Radhakrishnan V (2011) Gastric cancer in India. Indian J Med Paediatr Oncol 32:12–16CrossRefGoogle Scholar
  4. 4.
    GLOBOCAN Cancer fact sheets: stomach cancers [Internet]. Available from:
  5. 5.
    Cunningham D, Allum WH, Stenning SP, Thompson JN, van de Velde C, Nicolson M, Scarffe JH, Lofts FJ, Falk SJ, Iveson TJ, Smith DB, Langley RE, Verma M, Weeden S, Chua YJ, MAGIC Trial Participants (2006) Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 355:11–20CrossRefGoogle Scholar
  6. 6.
    Shrikhande SV, Barreto SG, Talole SD et al. (2013) “D2 lymphadenectomy is not only safe but necessary in the era of neoadjuvant chemotherapy,” World J Surg Oncol, vol. 11, article no. 31Google Scholar
  7. 7.
    Weledji EP, Verla V (2016) Failure to rescue patients from early critical complications of oesophagogastric cancer surgery. Ann Med Surg (Lond) 2:34–41CrossRefGoogle Scholar
  8. 8.
    Vasilescu C, Herlea V, Tidor S, Ivanov B, Stănciulea O, Mănuc M, Gheorghe C, Ionescu M, Diculescu M, Popescu I (2006) D2 lymph node dissection in gastric cancer surgery: long term results—analysis of an experience with 227 patients. Chirurgia (Bucur) 101:375–384Google Scholar
  9. 9.
    Cho BC, Jeung HC, Choi HJ, Rha SY, Hyung WJ, Cheong JH, Noh SH, Chung HC (2007) Prognostic impact of resection margin involvement after extended (D2/D3) gastrectomy for advanced gastric cancer: a 15-year experience at a single institute. J Surg Oncol 95:461–468CrossRefGoogle Scholar
  10. 10.
    Songun I, Putter H, Kranenbarg EMK, Sasako M, van de Velde CJ (2010) Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 11:439–449CrossRefGoogle Scholar
  11. 11.
    Shrikhande SV, Barreto SG, Talole SD, Vinchurkar K, Annaiah S, Suradkar K et al (2013) D2 lymphadenectomy is not only safe but necessary in the era of neoadjuvant chemotherapy. World J Surg Oncol 2:11–31Google Scholar
  12. 12.
    Shrikhande SV, Shukla PJ, Qureshi S, Siddachari R, Upasani V, Ramadwar M, Kakade AC, Hawaldar R (2006) D2 lymphadenectomy for gastric cancer in Tata Memorial Hospital: Indian data can now be incorporated in future international trials. Dig Surg 23:192–197CrossRefGoogle Scholar
  13. 13.
    Rajdev L (2010) Treatment options for surgically resectable gastric cancer. Curr Treat Options in Oncol 11:14–23CrossRefGoogle Scholar
  14. 14.
    Sano T (2008) Adjuvant and neoadjuvant therapy of gastric cancer: a comparison of three pivotal studies. Curr Oncol Rep 10:191–198CrossRefGoogle Scholar
  15. 15.
    Bozzetti F, Marubini E, Bonfanti G, Miceli R, Piano C, Gennari L, Italian Gastrointestinal Tumor Study Group (1999) Subtotal versus total gastrectomy for gastric cancer: five-year survival rates in a multicenter randomized Italian trial. Ann Surg 230(2):170–178. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Bonenkamp JJ, Hermans J, Sasako M et al (1999) Extended lymph-node dissection for gastric cancer. N Engl J Med 340(12):908–914. CrossRefPubMedGoogle Scholar
  17. 17.
    Ychou M, Boige V, Pignon JP, Conroy T, Bouché O, Lebreton G, Ducourtieux M, Bedenne L, Fabre JM, Saint-Aubert B, Genève J, Lasser P, Rougier P (2011) Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol 29:1715–1721CrossRefGoogle Scholar

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© Indian Association of Surgical Oncology 2019

Authors and Affiliations

  1. 1.Department of Surgical OncologyDr. B. Borooah Cancer InstituteGuwahatiIndia
  2. 2.Department of ProsthodonticsDental CollegeAzamgarhIndia

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