Nowadays gastric cancer is less common, but still remains a global phenomenon representing the second leading cause of cancer-related deaths worldwide, with 5-year survival rates of 20-25%. This chapter aims to discuss open issues in the surgical management of gastric malignancies in order to define the current principles of gastric cancer therapy. The validity and usefulness of the 7th edition of the AJCC/UICC tumor node metastases classification in the context of clinical management of gastric cancer are discussed. Despite considerable improvements in the management of gastric cancer over the past decades, surgery remains the mainstay of treatment, provided that the patient is medically fit. Aim of curative surgery is the complete primary tumor excision with a wide surgical dissection field that allows to obtain a safe "circumferential" margin and a lymphnode dissection larger than positive stations. In fact, long-term benefit of systematic D2 lymphadenectomy has now been shown in randomized trials. Further extension of lymphadenectomy, including para-aortic nodal dissection, should be restricted to selected high risk patients. Additionally, a hot topic in gastric cancer treatment debate is represented by the role of laparoscopy. The laparoscopic approach is strongly recommended for staging, whereas the use of minimally invasive surgery for resection and lymphadenectomy is still to be demonstrated. In locally advanced gastric cancer (as commonly diagnosed gastric cancer in Western countries) the multimodal treatment, in comparison to surgery alone, can improve survival with a better local and regional tumor control and with a reduction of systemic metastases rate. Multimodal treatment strategies, including perioperative chemotherapy and/or radiotherapy options, are analyzed in order to clarify their indications and results. Standardization of staging system, with accurate identification of prognostic factors, and multimodal approach are needed to achieve tailored therapeutic approaches, improving survival results in gastric cancer patients.

Clinical and surgical management of gastric cancer: Principles of treatment / S. Rausei, S. Spampatti, F. Galli, L. Ruspi, F. Rovera, L. Boni, G. Dionigi (CANCER ETIOLOGY, DIAGNOSIS AND TREATMENTS). - In: Gastric Cancer : Risk Factors, Treatment and Clinical Outcomes / [a cura di] J. Singh Bhullar. - [s.l] : Nova Science Publishers, 2014 Jun. - ISBN 978-1-63117-983-9. - pp. 171-193

Clinical and surgical management of gastric cancer: Principles of treatment

L. Boni
Penultimo
;
G. Dionigi
Ultimo
2014

Abstract

Nowadays gastric cancer is less common, but still remains a global phenomenon representing the second leading cause of cancer-related deaths worldwide, with 5-year survival rates of 20-25%. This chapter aims to discuss open issues in the surgical management of gastric malignancies in order to define the current principles of gastric cancer therapy. The validity and usefulness of the 7th edition of the AJCC/UICC tumor node metastases classification in the context of clinical management of gastric cancer are discussed. Despite considerable improvements in the management of gastric cancer over the past decades, surgery remains the mainstay of treatment, provided that the patient is medically fit. Aim of curative surgery is the complete primary tumor excision with a wide surgical dissection field that allows to obtain a safe "circumferential" margin and a lymphnode dissection larger than positive stations. In fact, long-term benefit of systematic D2 lymphadenectomy has now been shown in randomized trials. Further extension of lymphadenectomy, including para-aortic nodal dissection, should be restricted to selected high risk patients. Additionally, a hot topic in gastric cancer treatment debate is represented by the role of laparoscopy. The laparoscopic approach is strongly recommended for staging, whereas the use of minimally invasive surgery for resection and lymphadenectomy is still to be demonstrated. In locally advanced gastric cancer (as commonly diagnosed gastric cancer in Western countries) the multimodal treatment, in comparison to surgery alone, can improve survival with a better local and regional tumor control and with a reduction of systemic metastases rate. Multimodal treatment strategies, including perioperative chemotherapy and/or radiotherapy options, are analyzed in order to clarify their indications and results. Standardization of staging system, with accurate identification of prognostic factors, and multimodal approach are needed to achieve tailored therapeutic approaches, improving survival results in gastric cancer patients.
Settore MED/18 - Chirurgia Generale
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/882944
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