Natalie Coburn1, Roxanne Cosby2, Laz Klein3, Gregory Knight4, Richard Malthaner5, Joseph Mamazza6, C Dale Mercer7, Jolie Ringash8. 1. Odette Cancer Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada. Electronic address: natalie.coburn@sunnybrook.ca. 2. Program in Evidence-Based Care, Department of Oncology, McMaster University, Juravinski Campus, 711 Concession Street, Hamilton, ON L8V 1C3, Canada. Electronic address: cosbyr@mcmaster.ca. 3. Humber River Regional Hospital, 1235 Wilson Avenue, Toronto, ON M3M 0B2, Canada. Electronic address: l.klein@utoronto.ca. 4. Grand River Regional Cancer Centre, 835 King Street West, Kitchener, ON N2G 1G3, Canada. Electronic address: gregory.knight@grhosp.on.ca. 5. London Regional Cancer Program, 800 Commissioners Road East, London, ON N6A 5W9, Canada. Electronic address: richard.malthaner@lhsc.on.ca. 6. Ottawa Civic Hospital, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada. Electronic address: jmamazza@ottawahospital.on.ca. 7. Hotel Dieu Hospital, 166 Brock Street, Kingston, ON K7L 5G2, Canada. Electronic address: mercerd@kgh.kari.net. 8. Princess Margaret Cancer Centre and the University of Toronto, 610 University Avenue, Toronto, ON M5G 2M9, Canada. Electronic address: jolie.ringash@rmp.uhn.on.ca.
Abstract
BACKGROUND: Gastric adenocarcinoma accounted for 6.8% of new cancer cases and 8.8% of cancer deaths worldwide in 2012. Although resection is the cornerstone for cure, several aspects of surgical intervention remain controversial or sub-optimally applied at the population level. These include staging, extent of lymph node dissection (LND), optimal requirements of LN assessment, minimum resection margins, surgical technique (laparoscopic vs. open), relationship between surgical volumes and patient outcomes, and resection of stage IV gastric cancer. METHODS: A systematic review was conducted to inform surgical care. RESULTS: The evidence included in this systematic review consists of one guideline, seven systematic reviews and 48 primary studies. CONCLUSIONS: All patients should be discussed at a multidisciplinary team meeting and a staging CT of the chest and abdomen should always be performed. Diagnostic laparoscopy should be performed in patients at risk for stage IV disease. A D2 LND is preferred for curative-intent resection in advanced non-metastatic gastric cancer. At least 16 LNs should be assessed for adequate staging of curative-resected gastric cancer. Gastric cancer surgery should aim to achieve an RO resection margin. In the metastatic setting, surgery should only be considered for palliation of symptoms. Patients should be referred to higher volume centres, and those with adequate support to manage potential complications. Laparoscopic resections should be performed to the same standards as open resections.
BACKGROUND: Gastric adenocarcinoma accounted for 6.8% of new cancer cases and 8.8% of cancer deaths worldwide in 2012. Although resection is the cornerstone for cure, several aspects of surgical intervention remain controversial or sub-optimally applied at the population level. These include staging, extent of lymph node dissection (LND), optimal requirements of LN assessment, minimum resection margins, surgical technique (laparoscopic vs. open), relationship between surgical volumes and patient outcomes, and resection of stage IV gastric cancer. METHODS: A systematic review was conducted to inform surgical care. RESULTS: The evidence included in this systematic review consists of one guideline, seven systematic reviews and 48 primary studies. CONCLUSIONS: All patients should be discussed at a multidisciplinary team meeting and a staging CT of the chest and abdomen should always be performed. Diagnostic laparoscopy should be performed in patients at risk for stage IV disease. A D2 LND is preferred for curative-intent resection in advanced non-metastatic gastric cancer. At least 16 LNs should be assessed for adequate staging of curative-resected gastric cancer. Gastric cancer surgery should aim to achieve an RO resection margin. In the metastatic setting, surgery should only be considered for palliation of symptoms. Patients should be referred to higher volume centres, and those with adequate support to manage potential complications. Laparoscopic resections should be performed to the same standards as open resections.
Authors: Dolores Müller; Raphael Stier; Jennifer Straatman; Benjamin Babic; Lars Schiffmann; Jennifer Eckhoff; Thomas Schmidt; Christiane Bruns; Hans F Fuchs Journal: Chirurgie (Heidelb) Date: 2022-06-03