Skip to main content
SpringerLink
Log in

Surgical Strategies in Gastric Cancer

  • Chapter
  • First Online:
Gastric Cancer In The Precision Medicine Era

Part of the book series: Current Clinical Pathology ((CCPATH))

  • 594 Accesses

Abstract

Surgery plays a central role in the multimodality management of gastric cancer including staging evaluation, curative treatment, and palliation. In the staging process, laparoscopy allows for accurate assessment of peritoneal spreading. During the same procedure, peritoneal washing cytology is performed. In patients with positive cytology, hyperthermic intraperitoneal chemotherapy (HIPEC) is being explored in selected cases. Radical surgery of gastric cancer includes adequate resection margins and lymph node dissection. In patients with resectable tumors, the extent of stomach resection and lymph node dissection are the two main issues to be considered when planning radical surgery for gastric cancer. In cases with initially unresectable but nonmetastatic gastric cancer, conversion preoperative multimodality treatment is under investigation. Metastasectomy for liver or lung gastric cancer metastasis is very rarely indicated. In patients with locally advanced or metastatic disease, palliative gastrectomy can provide symptomatic relief.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), 2010. https://www.sages.org/publications/guidelines/guidelines-for-diagnostic-laparoscopy/.

  2. Smyth EC, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D, ESMO Guidelines Committee. Gastric cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27:v38–49.

    Article  CAS  Google Scholar 

  3. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Gastric Cancer (Version 1.2018). http://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf. Accessed on May 2018.

  4. De Manzoni G, Marrelli D, Baiocchi GL, et al. The Italian Research Group for Gastric Cancer (GIRCG) guidelines for gastric cancer staging and treatment: 2015. Gastric Cancer. 2017;20:20–30.

    Article  Google Scholar 

  5. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20(1):1–19. https://doi.org/10.1007/s10120-016-0622-4.

    Article  Google Scholar 

  6. De Andrade JP, Mezhir JJ. The critical role of peritoneal cytology in the staging of gastric cancer: an evidence-based review. J Surg Oncol. 2014;110(3):291–7. https://doi.org/10.1002/jso.23632. Epub 2014 May 22. Review. PubMed PMID: 24850538.

    Article  PubMed  Google Scholar 

  7. Desiderio J, Chao J, Melstrom L, et al. The 30-year experience-a meta-analysis of randomised and high-quality non-randomised studies of hyperthermic intraperitoneal chemotherapy in the treatment of gastric cancer. Eur J Cancer. 2017;79:1–14. https://doi.org/10.1016/j.ejca.2017.03.030. Epub 2017 Apr 26. Review. PubMed PMID: 28456089; PubMed Central PMCID: PMC5568419.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Smyth EC, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D, ESMO Guidelines Committee. Gastric cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27(suppl 5):v38–49. PubMed PMID: 27664260.

    Article  CAS  Google Scholar 

  9. Postlewait LM, Maithel SK. The importance of surgical margins in gastric cancer. J Surg Oncol. 2016;113(3):277–82. https://doi.org/10.1002/jso.24110. Epub 2015 Dec 10. Review. PubMed PMID: 26662226.

    Article  PubMed  Google Scholar 

  10. Ajani JA, In H, Sano T, et al. Stomach. In: Amin MB, editor. AJCC cancer staging manual. 8th ed. Chicago: AJCC; 2017. p. 203.

    Chapter  Google Scholar 

  11. de Manzoni G, Verlato G, Roviello F, et al. The new TNM classification of lymph node metastasis minimises stage migration problems in gastric cancer patients. Br J Cancer. 2002;87:171.

    Article  Google Scholar 

  12. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomized nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11(5):439–49. https://doi.org/10.1016/S1470-2045(10)70070-X. Epub 2010 Apr 19. PubMed PMID: 20409751.

    Article  PubMed  Google Scholar 

  13. Mocellin S, McCulloch P, Kazi H, Gama-Rodrigues JJ, Yuan Y, Nitti D. Extent of lymph node dissection for adenocarcinoma of the stomach. Cochrane Database Syst Rev. 2015;8:CD001964. https://doi.org/10.1002/14651858.CD001964.pub4. Review. PubMed PMID: 26267122.

    Article  Google Scholar 

  14. Hanna GB, Boshier PR, Knaggs A, Goldin R, Sasako M. Improving outcomes after gastroesophageal cancer resection: can Japanese results be reproduced in Western centers? Arch Surg. 2012;147(8):738–45. https://doi.org/10.1001/archsurg.2012.983. PubMed PMID: 22911070.

    Article  PubMed  Google Scholar 

  15. Kim W, Kim HH, Han SU, Kim MC, Hyung WJ, Ryu SW, Cho GS, Kim CY, Yang HK, Park DJ, Song KY, Lee SI, Ryu SY, Lee JH, Lee HJ, Korean Laparo-endoscopic Gastrointestinal Surgery Study (KLASS) Group. Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg. 2016;263(1):28–35. https://doi.org/10.1097/SLA.0000000000001346. PubMed PMID: 26352529.

    Article  PubMed  Google Scholar 

  16. Shi Y, Xu X, Zhao Y, Qian F, Tang B, Hao Y, Luo H, Chen J, Yu P. Short-term surgical outcomes of a randomized controlled trial comparing laparoscopic versus open gastrectomy with D2 lymph node dissection for advanced gastric cancer. Surg Endosc. 2018;32(5):2427–33. https://doi.org/10.1007/s00464-017-5942-x. Epub 2017 Dec 12. PubMed PMID: 29234941.

    Article  PubMed  Google Scholar 

  17. Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, Xue Y, Suo J, Tao K, He X, Wei H, Ying M, Hu W, Du X, Chen P, Liu H, Zheng C, Liu F, Yu J, Li Z, Zhao G, Chen X, Wang K, Li P, Xing J, Li G. Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol. 2016;34(12):1350–7. https://doi.org/10.1200/JCO.2015.63.7215. Epub 2016 Feb 22. PubMed PMID: 26903580.

    Article  PubMed  Google Scholar 

  18. Fukuchi M, Ishiguro T, Ogata K, Suzuki O, Kumagai Y, Ishibashi K, Ishida H, Kuwano H, Mochiki E. Prognostic role of conversion surgery for unresectable gastric cancer. Ann Surg Oncol. 2015;22(11):3618–24. https://doi.org/10.1245/s10434-015-4422-6. Epub 2015 Feb 7. PubMed PMID: 25663597.

    Article  PubMed  Google Scholar 

  19. Cho H, Nakamura J, Asaumi Y, Yabusaki H, Sakon M, Takasu N, Kobayashi T, Aoki T, Shiraishi O, Kishimoto H, Nunobe S, Yanagisawa S, Suda T, Ueshima S, Matono S, Maruyama H, Tatsumi M, Seya T, Tanizawa Y, Yoshikawa T. Long-term survival outcomes of advanced gastric cancer patients who achieved a pathological complete response with neoadjuvant chemotherapy: a systematic review of the literature. Ann Surg Oncol. 2015;22(3):787–92. https://doi.org/10.1245/s10434-014-4084-9. Epub 2014 Sep 16. Review. PubMed PMID: 25223927.

    Article  PubMed  Google Scholar 

  20. Tomasello G, Petrelli F, Ghidini M, Pezzica E, Passalacqua R, Steccanella F, Turati L, Sgroi G, Barni S. Tumor regression grade and survival after neoadjuvant treatment in gastro-esophageal cancer: a meta-analysis of 17 published studies. Eur J Surg Oncol. 2017;43(9):1607–16. https://doi.org/10.1016/j.ejso.2017.03.001. Epub 2017 Mar 18. Review. PubMed PMID: 28347525.

    Article  CAS  PubMed  Google Scholar 

  21. Li Z, Shan F, Wang Y, Zhang Y, Zhang L, Li S, Jia Y, Xue K, Miao R, Li Z, Ji J. Correlation of pathological complete response with survival after neoadjuvant chemotherapy in gastric or gastroesophageal junction cancer treated with radical surgery: a meta-analysis. PLoS One. 2018;13(1):e0189294. https://doi.org/10.1371/journal.pone.0189294. eCollection 2018. PubMed PMID: 29370182; PubMed Central PMCID: PMC5784899.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Blackham AU, Swords DS, Levine EA, Fino NF, Squires MH, Poultsides G, Fields RC, Bloomston M, Weber SM, Pawlik TM, Jin LX, Spolverato G, Schmidt C, Worhunsky D, Cho CS, Maithel SK, Votanopoulos KI. Is linitis plastica a contraindication for surgical resection: a multi-institution study of the U.S. gastric cancer collaborative. Ann Surg Oncol. 2016;23(4):1203–11. https://doi.org/10.1245/s10434-015-4947-8. Epub 2015 Nov 3. PubMed PMID: 26530447; PubMed Central PMCID: PMC4980579.

    Article  PubMed  Google Scholar 

  23. Chang JM, Lara KA, Gray RJ, Pockaj BA, Wasif N. Clinical outcomes after surgery for linitis plastica of the stomach: analysis of a population cancer registry. Am Surg. 2017;83(1):23–9. PubMed PMID: 28234115.

    PubMed  Google Scholar 

  24. Marrelli D, Roviello F, De Stefano A, et al. Risk factors for liver metastases after curative surgical procedures for gastric cancer: a prospective study of 208 patients treated with surgical resection. J Am Coll Surg. 2004;198:51–8.

    Article  Google Scholar 

  25. Okano K, Maeba T, Ishimura K, et al. Hepatic resection for metastatic tumors from gastric cancer. Ann Surg. 2002;235:86–91.

    Article  Google Scholar 

  26. Sakamoto Y, Ohyama S, Yamamoto J, et al. Surgical resection of liver metastases of gastric cancer: an analysis of a 17-year experience with 22 patients. Surgery. 2003;133:507–11.

    Article  Google Scholar 

  27. Zacherl J, Zacherl M, Scheuba C, et al. Analysis of hepatic resection of metastasis originating from gastric adenocarcinoma. J Gastrointest Surg. 2002;6:682–9.

    Article  Google Scholar 

  28. Sakamoto Y, Sano T, Shimada K, et al. Favorable indications for hepatectomy in patients with liver metastasis from gastric cancer. J Surg Oncol. 2007;95:534–9.

    Article  Google Scholar 

  29. Takahashi I, Kakeji Y, Emi Y, et al. S-1 in the treatment of advanced and recurrent gastric cancer: current state and future prospects. Gastric Cancer. 2003;6(Suppl 1):28–33.

    Article  Google Scholar 

  30. Elias D, Cavalcanti de Albuquerque A, Eggenspieler P, et al. Resection of liver metastases from a noncolorectal primary: indications and results based on 147 monocentric patients. J Am Coll Surg. 1998;187:487–93.

    Article  CAS  Google Scholar 

  31. Harrison LE, Brennan MF, Newman E, et al. Hepatic resection for non-colorectal, non-neuroendocrine metastases: a fifteen-year experience with ninety-six patients. Surgery. 1997;121:625–32.

    Article  CAS  Google Scholar 

  32. Hirai I, Kimura W, Fuse A, et al. Surgical management for metastatic liver tumors. Hepatogastroenterology. 2006;53:757–63.

    PubMed  Google Scholar 

  33. Ambiru S, Miyazaki M, Ito H, et al. Benefits and limits of hepatic resection for gastric metastases. Am J Surg. 2001;181:279–83.

    Article  CAS  Google Scholar 

  34. Bines SD, England G, Deziel DJ, et al. Synchronous, metachronous, and multiple hepatic resections of liver tumors originating from primary gastric tumors. Surgery. 1993;114:799–805; discussion 804–795.

    CAS  PubMed  Google Scholar 

  35. Miyazaki M, Itoh H, Nakagawa K, et al. Hepatic resection of liver metastases from gastric carcinoma. Am J Gastroenterol. 1997;92:490–3.

    CAS  PubMed  Google Scholar 

  36. Ochiai T, Sasako M, Mizuno S, et al. Hepatic resection for metastatic tumours from gastric cancer: analysis of prognostic factors. Br J Surg. 1994;81:1175–8.

    Article  CAS  Google Scholar 

  37. Saiura A, Umekita N, Inoue S, et al. Clinicopathological features and outcome of hepatic resection for liver metastasis from gastric cancer. Hepatogastroenterology. 2002;49:1062–5.

    PubMed  Google Scholar 

  38. Shirabe K, Shimada M, Matsumata T, et al. Analysis of the prognostic factors for liver metastasis of gastric cancer after hepatic resection: a multi-institutional study of the indications for resection. Hepatogastroenterology. 2003;50:1560–3.

    PubMed  Google Scholar 

  39. Cheon SH, Rha SY, Jeung HC, Im CK, Kim SH, Kim HR, Ahn JB, Roh JK, Noh SH, Chung HC. Survival benefit of combined curative resection of the stomach (D2 resection) and liver in gastric cancer patients with liver metastases. Ann Oncol. 2008;19(6):1146–53.

    Article  CAS  Google Scholar 

  40. Catalano V, Labianca R, Beretta GD, Gatta G, de Braud F, Van Cutsem E. Gastric Cancer. Crit Rev Oncol Hematol. 2009;71:127–64.

    Article  Google Scholar 

  41. Wagner AD, Unverzagt S, Grothe W, et al. Chemotherapy for advanced gastric cancer. Cochrane Database Syst Rev. 2010;3:CD004064.

    Google Scholar 

  42. Tey J, Back MF, Shakespeare TP, et al. The role of palliative radiation therapy in symptomatic locally advanced gastric cancer. Int J Radiat Oncol Biol Phys. 2007;67:385.

    Article  Google Scholar 

  43. Harvey JA, Bessell JR, Beller E, et al. Chemoradiation therapy is effective for the palliative treatment of malignant dysphagia. Dis Esophagus. 2004;17:260.

    Article  CAS  Google Scholar 

  44. Tey J, Choo BA, Leong CN, et al. Clinical outcome of palliative radiotherapy for locally advanced symptomatic gastric cancer in the modern era. Medicine (Baltimore). 2014;93:e118.

    Article  Google Scholar 

  45. Jeurnink SM, van Eijck CH, Steyerberg EW, et al. Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review. BMC Gastroenterol. 2007;7:18.

    Article  Google Scholar 

  46. Barr H, Krasner N. Interstitial laser photocoagulation for treating bleeding gastric cancer. BMJ. 1989;299:659.

    Article  CAS  Google Scholar 

  47. Pittayanon R, Rerknimitr R, Barkun A. Prognostic factors affecting outcomes in patients with malignant GI bleeding treated with a novel endoscopically delivered hemostatic powder. Gastrointest Endosc. 2018;87:994.

    Article  Google Scholar 

  48. Mariette C, Bruyère E, Messager M, et al. Palliative resection for advanced gastric and junctional adenocarcinoma: which patients will benefit from surgery? Ann Surg Oncol. 2013;20:1240.

    Article  Google Scholar 

  49. Fujitani K, Yang HK, Mizusawa J, et al. Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trial. Lancet Oncol. 2016;17:309.

    Article  CAS  Google Scholar 

  50. Takeno A, Takiguchi S, Fujita J, et al. Clinical outcome and indications for palliative gastrojejunostomy in unresectable advanced gastric cancer: multi-institutional retrospective analysis. Ann Surg Oncol. 2013;20:3527.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Surgical Oncology Department, IRCCS, CRO Aviano, National Cancer Institute, Aviano, PN, Italy

    Claudio Belluco, Matteo Olivieri, Andrea Lauretta, Danilo Antona & Giulio Bertola

  2. Radiation Oncology Department, IRCCS, CRO Aviano, National Cancer Institute, Aviano, PN, Italy

    Antonino De Paoli & Federico Navarria

  3. Medical Oncology Department, IRCCS, CRO Aviano, National Cancer Institute, Aviano, PN, Italy

    Angela Buonadonna & Michela Guardascione

  4. Oncological Gastroenterology Department, IRCCS, CRO Aviano, National Cancer Institute, Aviano, PN, Italy

    Renato Cannizzaro

  5. Pathology Department, IRCCS, CRO Aviano, National Cancer Institute, Aviano, PN, Italy

    Vincenzo Canzonieri

  6. Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy

    Vincenzo Canzonieri

  7. CRO Biobank, IRCCS, CRO Aviano, National Cancer Institute, Aviano, Italy

    Vincenzo Canzonieri

  8. Department of Biology, Temple University, Philadelphia, PA, USA

    Vincenzo Canzonieri

Authors
  1. Claudio Belluco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matteo Olivieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea Lauretta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Danilo Antona
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Antonino De Paoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Federico Navarria
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Angela Buonadonna
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michela Guardascione
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Renato Cannizzaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Vincenzo Canzonieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Giulio Bertola
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Claudio Belluco .

Editor information

Editors and Affiliations

  1. Pathology Unit and Biobank, CRO-Aviano, IRCCS, National Cancer Institute, Aviano, Italy

    Vincenzo Canzonieri

  2. Sbarro Institute for Cancer, Research and Molecular Medicine, Department of Biology, Temple University, Philadelphia, PA, USA

    Antonio Giordano

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Belluco, C. et al. (2019). Surgical Strategies in Gastric Cancer. In: Canzonieri, V., Giordano, A. (eds) Gastric Cancer In The Precision Medicine Era. Current Clinical Pathology. Humana, Cham. https://doi.org/10.1007/978-3-030-04861-7_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-04861-7_9

  • Published:

  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-04860-0

  • Online ISBN: 978-3-030-04861-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation