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Advances in the management of gastric cancer

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Abstract

Gastric cancer is a common malignancy in our country and patients continue to present at an advanced stage. Following confirmation of diagnosis, CT scan, endoscopic ultrasound and laparoscopy are the essential staging modalities. Radical gastrectomy remains the initial treatment of choice. Although controversy persists about the extent of lymph node dissection, there is a general consensus in performing D2 dissection but with preservation of pancreas and spleen. Patients who have high risk of relapse are treated with postoperative chemoradiotherapy. The regimen of preoperative chemotherapy followed by gastrectomy and postoperative chemotherapy has also become important in recent years. Both these chemotherapeutic options confer survival advantage and patients need to be appraised about various treatment strategies at the very outset.

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References

  1. National Cancer Registry Programme (ICMR). Population based cancer registry 2004–2005. http://www.pbcrindia.org

  2. Yeole BB (2008) Trends in cancer incidence in esophagus, stomach, colon, rectum and liver in males in India. Asian Pac J Cancer Prev 9(1):97–100

    PubMed  Google Scholar 

  3. 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(3):192–197

    Article  PubMed  Google Scholar 

  4. National Comprehensive Cancer Network Clinical Pratice Guidelines in Oncology. Gastric Cancer V.2.2009. http://www.nccn.org

  5. Jadvar H, Tatlidil R, Garcia AA, Conti PS (2003) Evaluation of recurrent gastric malignancy with [F-18]-FDG positron emission tomography. Clin Radiol 58(3):215–221

    Article  CAS  PubMed  Google Scholar 

  6. Tsendsuren T, Jun SM, Mian XH (2006) Usefulness of endoscopic ultrasonography in preoperative TNM staging of gastric cancer. World J Gastroenterol 12(1):43–47

    PubMed  Google Scholar 

  7. Sarela AI, Lefkowitz R, Brennan MF, Karpeh MS (2006) Selection of patients with gastric adenocarcinoma for laparoscopic staging. Am J Surg 191(1):134–138

    Article  PubMed  Google Scholar 

  8. Bentrem D, Wilton A, Mazumdar M, Brennan M, Coit D (2005) The value of peritoneal cytology as a preoperative predictor in patients with gastric carcinoma undergoing a curative resection. Ann Surg Oncol 12(5):347–353

    Article  PubMed  Google Scholar 

  9. Bentrem D, Gerdes H, Tang L, Brennan M, Coit D (2007) Clinical correlation of endoscopic ultrasonography with pathologic stage and outcome in patients undergoing curative resection for gastric cancer. Ann Surg Oncol 14(6):1853–1859

    Article  PubMed  Google Scholar 

  10. Sarela AI, Miner TJ, Karpeh MS, Coit DG, Jaques DP, Brennan MF (2006) Clinical outcomes with laparoscopic stage M1, unresected gastric adenocarcinoma. Ann Surg 243(2):189–195

    Article  PubMed  Google Scholar 

  11. Maruyama K, Okabayashi K, Kinoshita T (1987) Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg 11(4):418–425

    Article  CAS  PubMed  Google Scholar 

  12. Bunt AM, Hermans J, Smit VT, van de Velde CJ, Fleuren GJ, Bruijn JA (1995) Surgical/pathologic-stage migration confounds comparisons of gastric cancer survival rates between Japan and Western countries. J Clin Oncol 13(1):19–25

    CAS  PubMed  Google Scholar 

  13. Sasako M, McCulloch P, Kinoshita T, Maruyama K (1995) New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg 82(3):346–351

    Article  CAS  PubMed  Google Scholar 

  14. Sue-Ling H (2007) Radical D2 gastrectomy for cancer. The case of D2 resections. Ann R Coll Surg Engl 89(7):672–674

    Article  PubMed  Google Scholar 

  15. Gall FP, Hermanek P (1985) New aspects in the surgical treatment of gastric carcinoma — a comparative study of 1636 patients operated on between 1969 and 1982. Eur J Surg Oncol 11:219–225

    CAS  PubMed  Google Scholar 

  16. Shiu MH, Moore E, Sanders M Huvos A, Freedman B, Goodbold J, Chaiyaphruk S, Wesdorp R, Brennan MF (1987) Influence of the extent of resection on survival after curative treatment of gastric carcinoma. A retrospective multivariate analysis. Arch Surg 122:1347–1351

    CAS  PubMed  Google Scholar 

  17. Gunderson LL, Sosin H (1982) Adenocarcinoma of the stomach: areas of failure in a re-operation series (second or symptomatic look) clinicopathologic correlation and implications for adjuvant therapy. Int J Radiat Oncol Biol Phys 8(1):1–11

    CAS  PubMed  Google Scholar 

  18. Ochiai T, Sasako M, Mizuno S, Kinoshita T, Takayama T, Kosuge T, Yamazaki S, Maruyama K (1994) Hepatic resection for metastatic tumours from gastric cancer: analysis of prognostic factors. Br J Surg 81(8):1175–1178

    Article  CAS  PubMed  Google Scholar 

  19. Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, Cook P (1996) Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet 347(9007):995–999

    Article  CAS  PubMed  Google Scholar 

  20. Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, Sydes M, Fayers P (1999) Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer 79(9–10):1522–1530

    CAS  Google Scholar 

  21. Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, van Elk P, Obertop H, Gouma DJ, Taat CW, et al. (1995) Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 345(8952):745–748

    Article  CAS  PubMed  Google Scholar 

  22. Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ, Welvaart K, Songun I, Meyer S, Plukker JT, Van Elk P, Obertop H, Gouma DJ, van Lanschot JJ, Taat CW, de Graaf PW, von Meyenfeldt MF, Tilanus H (1999) Dutch Gastric Cancer Group. Extended lymph-node dissection for gastric cancer. N Engl J Med 340(12):908–914

    Article  CAS  PubMed  Google Scholar 

  23. Hartgrink HH, van de Velde CJ, Putter H, Bonenkamp JJ, Klein Kranenbarg E, Songun I, Welvaart K, van Krieken JH, Meijer S, Plukker JT, van Elk PJ, Obertop H, Gouma DJ, van Lanschot JJ, Taat CW, de Graaf PW, von Meyenfeldt MF, Tilanus H, Sasako M (2004) Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol 22(11):2069–2077

    Article  CAS  PubMed  Google Scholar 

  24. Sue-Ling HM, Johnston D (1995) D1 versus D2 dissection for gastric cancer. Lancet 345(8963):1515–1516

    Article  CAS  PubMed  Google Scholar 

  25. Parikh D, Johnson M, Chagla L, Lowe D, McCulloch P (1996) D2 gastrectomy: lessons from a prospective audit of the learning curve. Br J Surg 83(11):1595–1599

    Article  CAS  PubMed  Google Scholar 

  26. Brennan MF (1999) Lymph-node dissection for gastric cancer N Engl J Med 340(12):956–958

    Article  CAS  PubMed  Google Scholar 

  27. Sasako M (2000) Surgery for gastric cancer. In: Recent Advances in Surgery. 23rd edition, Harcourt Publishers Ltd., Delhi, pp.11–21

    Google Scholar 

  28. Sano T, Katai H, Sasako M, Maruyama K (2002) One thousand consecutive gastrectomies without operative mortality. Br J Surg 89(1):123

    CAS  PubMed  Google Scholar 

  29. Mullen JT, Pisters PWT (2007) Subtotal gastrectomy for gastric cancer. In: Mastery of Surgery. 5th edition, Lippincott Williams & Wilkins, Philadelphia, pp. 927–937

    Google Scholar 

  30. Otsuji E, Yamaguchi T, Sawai K, Okamoto K, Takahashi T (1997) End results of simultaneous pancreatectomy, splenectomy and total gastrectomy for patients with gastric carcinoma. Br J Cancer 75(8):1219–1223

    CAS  PubMed  Google Scholar 

  31. Griffith JP, Sue-Ling HM, Martin I, Dixon MF, McMahon MJ, Axon AT, Johnston D (1995) Preservation of the spleen improves survival after radical surgery for gastric cancer. Gut 36(5):684–690

    Article  CAS  PubMed  Google Scholar 

  32. Csendes A, Burdiles P, Rojas J, Braghetto I, Diaz JC, Maluenda F (2002) A prospective randomized study comparing D2 total gastrectomy versus D2 total gastrectomy plus splenectomy in 187 patients with gastric carcinoma. Surgery 131(4): 401–407

    Article  PubMed  Google Scholar 

  33. Weitz J, Jaques DP, Brennan M, Karpeh M (2004) Association of splenectomy with postoperative complications in patients with proximal gastric and gastroesophageal junction cancer. Ann Surg Oncol 11(7):682–689

    Article  PubMed  Google Scholar 

  34. McCulloch P, Nita ME, Kazi H, Gama-Rodrigues J (2004) Extended versus limited lymph nodes dissection technique for adenocarcinoma of the stomach. Cochrane Database Syst Rev 18;(4):CD001964

    Google Scholar 

  35. Degiuli M, Sasako M, Calgaro M, Garino M, Rebecchi F, Mineccia M, Scaglione D, Andreone D, Ponti A, Calvo F Italian Gastric Cancer Study Group (2004) Morbidity and mortality after D1 and D2 gastrectomy for cancer: interim analysis of the Italian Gastric Cancer Study Group (IGCSG) randomised surgical trial. Eur J Surg Oncol 30(3):303–308

    Article  CAS  PubMed  Google Scholar 

  36. Siewert JR, Böttcher K, Roder JD, Busch R, Hermanek P, Meyer HJ (1993). Prognostic relevance of systematic lymph node dissection in gastric carcinoma. German Gastric Carcinoma Study Group. Br J Surg 80(8):1015–1018

    Article  CAS  PubMed  Google Scholar 

  37. Wu CW, Hsiung CA, Lo SS, Hsieh MC, Chen JH, Li AF, Lui WY, Whang-Peng J (2006) Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol 7(4):309–315

    Article  CAS  PubMed  Google Scholar 

  38. Karpeh MS, Leon L, Klimstra D, Brennan MF (2000) Lymph node staging in gastric cancer: is location more important than Number? An analysis of 1,038 patients. Ann Surg 232(3):362–371

    Article  CAS  PubMed  Google Scholar 

  39. Coburn NG (2009) Lymph nodes and gastric cancer. J Surg Oncol 99(4):199–206

    Article  PubMed  Google Scholar 

  40. Joyce DJ, McCulloch P (2007) Gastric cancer. In: Textbook of Surgical Oncology. Informa, London, pp. 172–181

    Google Scholar 

  41. Davies J, Johnston D, Sue-Ling H, Young S, May J, Griffith J, Miller G, Martin I (1998) Total or subtotal gastrectomy for gastric carcinoma? A study of quality of life. World J Surg 22(10):1048–1055

    Article  CAS  PubMed  Google Scholar 

  42. Harrison LE, Karpeh MS, Brennan MF (1998) Total gastrectomy is not necessary for proximal gastric cancer. Surgery 123(2):127–130

    CAS  PubMed  Google Scholar 

  43. Kim SH, Karpeh MS, Klimstra DS, Leung D, Brennan MF (1999) Effect of microscopic resection line disease on gastric cancer survival. J Gastrointest Surg 3(1):24–33

    Article  CAS  PubMed  Google Scholar 

  44. Reyes CD, Weber KJ, Gagner M, Divino CM (2001) Laparoscopic vs open gastrectomy. A retrospective review. Surg Endosc 15(9):928–931

    Article  CAS  PubMed  Google Scholar 

  45. Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241(2):232–237

    Article  PubMed  Google Scholar 

  46. Strong VE, Devaud N, Allen PJ, Gonen M, Brennan MF, Coit D (2009) Laparoscopic versus open subtotal gastrectomy for adenocarcinoma: a case-control study. Ann Surg Oncol 16(6):1507–1513

    Article  PubMed  Google Scholar 

  47. Hoya Y, Mitsumori N, Yanaga K (2009) The advantages and disadvantages of a Roux-en-Y reconstruction after a distal gastrectomy for gastric cancer. Surg Today 39(8):647–651

    Article  PubMed  Google Scholar 

  48. Mari E, Floriani I, Tinazzi A, Buda A, Belfiglio M, Valentini M, Cascinu S, Barni S, Labianca R, Torri V (2000) Efficacy of adjuvant chemotherapy after curative resection for gastric cancer: a meta-analysis of published randomised trials. A study of the GISCAD (Gruppo Italiano per lo Studio dei Carcinomi dell’Apparato Digerente). Ann Oncol 11(7):837–843

    Article  CAS  PubMed  Google Scholar 

  49. Wagner AD, Grothe W, Behl S, Kleber G, Grothey A, Haerting J, Fleig WE (2005) Chemotherapy for advanced gastric cancer. Cochrane Database Syst Rev (2):CD004064

    PubMed  Google Scholar 

  50. Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, Furukawa H, Nakajima T, Ohashi Y, Imamura H, Higashino M, Yamamura Y, Kurita A, Arai K; ACTS-GC Group (2007) Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 357(18): 1810–1820

    Article  CAS  PubMed  Google Scholar 

  51. Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, 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(1):11–20

    Article  CAS  PubMed  Google Scholar 

  52. Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, Haller DG, Ajani JA, Gunderson LL, Jessup JM, Martenson JA (2001) Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 345(10):725–730

    Article  CAS  PubMed  Google Scholar 

  53. Mansour JC, Tang L, Shah M, Bentrem D, Klimstra DS, Gonen M, Kelsen DP, Brennan MF, Coit DG (2007) Does graded histologic response after neoadjuvant chemotherapy predict survival for completely resected gastric cancer? Ann Surg Oncol 14(12):3412–3418

    Article  PubMed  Google Scholar 

  54. Ott K, Weber WA, Lordick F, Becker K, Busch R, Herrmann K, Wieder H, Fink U, Schwaiger M, Siewert JR (2006) Metabolic imaging predicts response, survival, and recurrence in adenocarcinomas of the esophagogastric junction. J Clin Oncol 24(29):4692–4698

    Article  PubMed  Google Scholar 

  55. House MG, Brennan MF (2008) Neoadjuvant therapy for gastric cancer. Advan Surg 42:151–168

    Article  Google Scholar 

  56. Catalano V, Graziano F, Santini D, D’Emidio S, Baldelli AM, Rossi D, Vincenzi B, Giordani P, Alessandroni P, Testa E, Tonini G, Catalano G (2008) Second-line chemotherapy for patients with advanced gastric cancer: who may benefit? Br J Cancer 99(9):1402–1407

    Article  CAS  PubMed  Google Scholar 

  57. Yamamoto S (2001) Stomach cancer incidence in the world Jpn J Clin Oncol 31:471–477

    Article  CAS  PubMed  Google Scholar 

  58. Huang JQ, Zheng GF, Sumanac K, Irvine EJ, Hunt RH (2003) Meta-analysis of the relationship between cagA seropositivity and gastric cancer. Gastroenterology 125(6): 1636–1644

    Article  PubMed  Google Scholar 

  59. Uemura N, Okamoto S, Yamamoto S, Matsumura N, Yamaguchi S, Yamakido M, Taniyama K, Sasaki N, Schlemper RJ (2001) Helicobacter pylori infection and the development of gastric cancer. N Engl J Med 345(11):784–789

    Article  CAS  PubMed  Google Scholar 

  60. Wong BC, Lam SK, Wong WM, Chen JS, Zheng TT, Feng RE, Lai KC, Hu WH, Yuen ST, Leung SY, Fong DY, Ho J, Ching CK, Chen JS (2004) Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: a randomized controlled trial. JAMA 291(2): 187–194

    Article  CAS  PubMed  Google Scholar 

  61. Del Giudice G, Malfertheiner P, Rappuoli R (2009) Development of vaccines against Helicobacter pylori. Expert Rev Vaccines 8(8):1037–1049

    Article  PubMed  Google Scholar 

  62. Bielanski W (1999) Epidemiological study on Helicobacter pylori infection and extragastroduodenal disorders in Polish population. J Physiol Pharmacol 50:723–733

    CAS  PubMed  Google Scholar 

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Correspondence to Manas Kumar Roy.

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Roy, M.K., Sadhu, S. & Dubey, S.K. Advances in the management of gastric cancer. Indian J Surg 71, 342–349 (2009). https://doi.org/10.1007/s12262-009-0092-6

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