Gastric cancer surgery - acknowledged and controversial opinions. Retrospective 10-year-analysis and discussion of current aspects

Background: Current problems in gastric cancer surgery concern the extent o f gastric resection, the need for abdominal evisceration, the degree of lym phadenectomy, and optimal preoperative tumor staging procedure. Patients an d methods: In a restrospective analysis, data on epidemiology, extent of su rgery, histopathology, postoperative complications, mortality, and survival in 284 gastric cancer patients were evaluated. Results: Our results are in favor of subtotal gastrectomy performed for all T stages located in the di stal or middle third, provided that a tumor-free margin of 5 cm in intestin al type and 10 cm in diffuse Lauren's type tumor can be achieved. Additiona l organ resections are indicated only if direct tumor invasion has occurred , and should not be part of an extended lymphadenectomy procedure. The degr ee of lymph node removal should be guided by the primary tumor site. Multim odal therapeutic approaches and high postoperative mortality after explorat ory laparotomy justify the use of diagnostic laparoscopy in T3/4 tumors and if diagnostic scans suggest possible tumor spread. Conclusion: Even though surgery for gastric cancer is well standardized, a tailored surgical appro ach to different extent of gastric cancer appears warranted.