Surgery

The best results are achieved in patients with T1N0 or T1N1 tumours; 70% of such patients are alive at five years. However, under 5% present with T1 tumours. Penetration of the serosa by the tumour predicts a risk of recurrence of 80-85%.

The type of operation will depend on the site of the tumour; oesophagogastrectomy may be required for cancers of the OGJ and proximal stomach, total gastrectomy for mid-stomach tumours, and partial gastrectomy may be adequate treatment for tumours in the distal stomach.

A further consideration is the extent of lymphadenectomy undertaken. In Japan, patients routinely undergo extensive lymphadenectomy, whereas in Western countries most patients have more limited lymph node resection. MRC and Dutch studies have compared R1 dissection (lymph nodes within 3 cm of the tumour) to R2 dissection (more extensive lymphadenectomy). In both studies postoperative mortality was significantly higher with R2 resection and no survival advantage has been observed. Consequently, R2 resection should not be used as standard treatment at present; long-term survival data are awaited from these studies.

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