A Multidisciplinary Approach to the Treatment of Gastric Cancer: What Is the Role of the Surgeon?


Despite recent declining incidence, gastric cancer remains one of the most common cancers worldwide. Its treatment involves a multidisciplinary team to ensure implementation of investigated pre-operative and post-operative treatment strategies to improve survival. Our aim is to discuss the current role of the surgeon in improving survival of gastric cancer patients.

Share and Cite:

A. El-Sedfy, F. Frankul and N. Coburn, "A Multidisciplinary Approach to the Treatment of Gastric Cancer: What Is the Role of the Surgeon?," Journal of Cancer Therapy, Vol. 4 No. 9A, 2013, pp. 16-26. doi: 10.4236/jct.2013.49A1003.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] J. Ferlay, H. R. Shin, F. Bray, D. Forman, C. Mathers and D. M. Parkin, “Estimates of Worldwide Burden of Cancer in 2008: GLOBOCAN 2008,” International Journal of Cancer, Vol. 127, No. 12, 2010, pp. 2893-2917. http://dx.doi.org/10.1002/ijc.25516
[2] R. Siegel, D. Naishadham and A. Jemal, “Cancer Statistics, 2013,” CA: A Cancer Journal for Clinicians, Vol. 63, No. 1, 2013, pp. 11-30. http://dx.doi.org/10.3322/caac.21166
[3] C. de Martel, D. Forman and M. Plummer, “Gastric Cancer: Epidemiology and Risk Factors,” Gastroenterology Clinics of North America, Vol. 42, No. 2, 2013, pp. 219-240. http://dx.doi.org/10.1016/ j.gtc. 2013.01.003
[4] W. Demark-Wahnefried, C. L. Rock, K. Patrick and T. Byers, “Lifestyle Interventions to Reduce Cancer Risk and Improve Outcomes,” American Family Physician, Vol. 77, No. 11, 2008, pp. 1573-1578.
[5] K. W. Jung, S. Park, H. J. Kong, Y. J. Won, J. Y. Lee, E. C. Park and J. S. Lee, “Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2008,” Cancer Research and Treatment, Vol. 43, No. 1, 2011, pp. 1-11. http://dx.doi.org/10.4143/crt.2011.43.1.1
[6] J. L. Whiting, A. Sigurdsson, D. C. Rowlands, M. T. Hallissey and J. W. Fielding, “The Long Term Results of Endoscopic Surveillance of Premalignant Gastric Lesions,” Gut, Vol. 50, No. 3, 2002, pp. 378-381. http://dx.doi.org/10.1136/gut.50.3.378
[7] V. E. Strong, K. Y. Song, C. H. Park, L. M. Jacks, M. Gonen, M. Shah, D. G. Coit and M. F. Brennan, “Comparison of Gastric Cancer Survival Following R0 Resection in the United States and Korea Using an Internationally Validated Nomogram,” Annals of Surgery, Vol. 251, No. 4, 2010, pp. 640-646. http://dx.doi.org/10.1097/SLA.0b013e3181d3d29b
[8] S. Brar, C. Law, R. McLeod, L. Helyer, C. Swallow, L. Paszat, R. Seevaratnam, R. Cardoso, M. Dixon, A. Mahar, L. G. Lourenco, L. Yohanathan, A. Bocicariu, T. BekaiiSaab, I. Chau, N. Church, D. Coit, C. H. Crane, C. Earle, P. Mansfield, N. Marcon, T. Miner, S. H. Noh, G. Porter, M. C. Posner, V. Prachand, T. Sano, C. van de Velde, S. Wong and N. Coburn, “Defining Surgical Quality in Gastric Cancer: A RAND/UCLA Appropriateness Study,” Journal of the American College of Surgeons, Vol. 215, No. 2, 2013, pp. 347-357. http://dx.doi.org/10.1016/j.jamcollsurg.2013.01.067
[9] N. G. Coburn, L. G. Lourenco, S. E. Rossi, N. Gunraj, A. L. Mahar, L. K. Helyer, C. Law, L. Rabeneck and L. Paszat, “Management of Gastric Cancer in Ontario,” Journal of Surgical Oncology, Vol. 102, No. 1, 2010, pp. 54-63. http://dx.doi.org/10.1002/jso.21561
[10] A. Donabedian, “The quality of Care. How Can It Be Assessed?” The Journal of the American Medical Association, Vol. 260, No. 12, 1988, pp. 1743-1748. http://dx.doi.org/10.1001/jama.1988.034101 20089033
[11] Japanese Gastric Cancer Association, “Japanese Gastric Cancer Treatment Guidelines 2010 (Version 3),” Gastric Cancer, Vol. 14, No. 2, 2011, pp. 113-123. http://dx.doi.org/10.1007/s10120-011-0042-4
[12] J. A. Ajani, D. J. Bentrem, S. Besh, T. A. D’Amico, P. Das, C. Denlinger, M. G. Fakih, C. S. Fuchs, H. Gerdes, R. E. Glasgow, J. A. Hayman, W. L. Hofstetter, D. H. Ilson, R. N. Keswani, L. R. Kleinberg, W. M. Korn, A. C. Lockhart, K. Meredith, M. F. Mulcahy, M. B. Orringer, J. A. Posey, A. R. Sasson, W. J. Scott, V. E. Strong, T. K. Varghese Jr., G. Warren, M. K. Washington, C. Willett, C. D. Wright, N. R. McMillian and H. Sundar, “Gastric Cancer, Version 2. 2013: Featured Updates to the NCCN Guidelines,” Journal of the National Comprehensive Cancer Network, Vol. 11, No. 5, 2013, pp. 531-546.
[13] D. Alderson, “Scottish Intercollegiate Guidelines Network (SIGN) 87—The Management of Oesophageal and Gastric Cancer,” Clinical Oncology (Royal College of Radiologists), Vol. 20, No. 7, 2008, pp. 530-531. http://dx.doi.org/10.1016/j.clon.2008.04.015
[14] W. H. Allum, J. M. Blazeby, S. M. Griffin, D. Cunningham, J. A. Jankowski and R. Wong, “Guidelines for the Management of Oesophageal and Gastric Cancer,” Gut, Vol. 60, No. 11, 2011, pp. 1449-1472. http://dx.doi.org/10.1136/gut.2010.228254
[15] E. Van Cutsem, M. Dicato, R. Geva, N. Arber, Y. Bang, A. Benson, A. Cervantes, E. Diaz-Rubio, M. Ducreux, R. Glynne-Jones, A. Grothey, D. Haller, K. Haustermans, D. Kerr, B. Nordlinger, J. Marshall, B. D. Minsky, Y. K. Kang, R. Labianca, F. Lordick, A. Ohtsu, N. Pavlidis, A. Roth, P. Rougier, H. J. Schmoll, A. Sobrero, J. Tabernero, C. Van de Velde and J. Zalcberg, “The Diagnosis and Management of Gastric Cancer: Expert Discussion and Recommendations from the 12th ESMO/World Congress on Gastrointestinal Cancer, Barcelona, 2010,” Annals of Oncology, Vol. 22, Supplement 5, 2011, pp. v1-v9. http://dx.doi.org/10.1093/annonc/mdr284
[16] J. D. Birkmeyer, Y. Sun, A. Goldfaden, N. J. Birkmeyer and T. A. Stukel, “Volume and Process of Care in HighRisk Cancer Surgery,” Cancer, Vol. 106, No. 11, 2006, pp. 2476-2481. http://dx.doi.org/10.1002/ cncr.21888
[17] P. Krijnen, M. den Dulk, E. Meershoek-Klein Kranenbarg, M. L. Jansen-Landheer and C. J. van de Velde, “Improved Survival after Resectable Non-Cardia Gastric Cancer in the Netherlands: The Importance of Surgical Training and Quality Control,” European Journal of Surgical Oncology, Vol. 35, No. 7, 2009, pp. 715-720. http://dx.doi.org/10.1016/j.ejso.2008.12.008
[18] M. Dixon, R. Cardoso, J. Tinmouth, L. Helyer, C. Law, C. Swallow, L. Paszat, R. McLeod, R. Seevaratnam, A. Mahar and N. G. Coburn, “What Studies Are Appropriate and Necessary for Staging Gastric Adenocarcinoma? Results of an International RAND/UCLA Expert Panel,” Gastric Cancer, Epub Ahead of Print, 2013. http://dx.doi.org/10.1007/s10120-013-0262-x
[19] E. K. Abdalla and P. W. Pisters, “Staging and Preoperative Evaluation of Upper Gastrointestinal Malignancies,” Seminars in Oncology, Vol. 31, No. 4, 2004, pp. 513-529. http://dx.doi.org/10.1053/ j.seminoncol. 2004.04.014
[20] R. M. Kwee and T. C. Kwee, “Imaging in Local Staging of Gastric Cancer: A Systematic Review,” Journal of Clinical Oncology, Vol. 25, No. 15, 2007, pp. 2107-2116. http://dx.doi.org/10.1200/JCO. 2006.09.5224
[21] W. A. Weber and K. Ott, “Imaging of Esophageal and Gastric Cancer,” Seminars in Oncology, Vol. 31, No. 4, 2004, pp. 530-541. http://dx.doi.org/10.1053/j.seminoncol.2004.04.016
[22] B. R. Smith and B. E. Stabile, “Gastric Adenocarcinoma: Reduction of Perioperative Mortality by Avoidance of Nontherapeutic Laparotomy,” Journal of Gastrointestinal Surgery, Vol. 11, No. 2, 2007: pp. 127-132. http://dx.doi.org/10.1007/s11605-006-0019-5
[23] C. D. Kemp, M. Kitano, S. Kerkar, R. T. Ripley, J. U. Marquardt, D. S. Schrump and I. Avital, “Pulmonary Resection for Metastatic Gastric Cancer,” Journal of Thoracic Oncology, Vol. 5, No. 11, 2010, pp. 1796-1805. http://dx.doi.org/10.1097/JTO.0b013e3181ed3514
[24] A. E. Dassen, D. J. Lips, C. J. Hoekstra, J. F. Pruijt and K. Bosscha, “FDG-PET Has No Definite Role in Preoperative Imaging in Gastric Cancer,” European Journal of Surgical Oncology, Vol. 35, No. 5, 2009, pp. 449-455. http://dx.doi.org/10.1016/j.ejso.2008.11.010
[25] J. Chen, J. H. Cheong, M. J. Yun, J. Kim, J. S. Lim, W. J. Hyung and S. H. Noh, “Improvement in Preoperative Staging of Gastric Adenocarcinoma with Positron Emission Tomography,” Cancer, Vol. 103, No. 11, 2005, pp. 2383-2390. http://dx.doi.org/10.1002/cncr.21074
[26] N. Coburn, R. Seevaratnam, L. Paszat, L. Helyer, C. Law, C. Swallow, R. Cardosa, A. Mahar, L. G. Lourenco, M. Dixon, T. Bekaii-Saab, I. Chau, N. Church, D. Coit, C. H. Crane, C. Earle, P. Mansfield, N. Marcon, T. Miner, S. H. Noh, G. Porter, M. C. Posner, V. Prachand, T. Sano, C. van de Velde, S. Wong and R. McLeod, “Optimal Management of Gastric Cancer: Results From an International RAND/UCLA Expert Panel,” Annals of Surgery, Epub Ahead of Print, 2013. http://dx.doi.org/10.1097/SLA. 0b013e318288dd2b
[27] S. R. Puli, J. Batapati Krishna Reddy, M. L. Bechtold, M. R. Antillon and J. A. Ibdah, “How Good Is Endoscopic Ultrasound for TNM Staging of Gastric Cancers? A Meta-Analysis and Systematic Review,” World Journal of Gastroenterology, Vol. 14, No. 25, 2008, pp. 4011-4019. http://dx.doi.org/10.3748/ wjg.14.4011
[28] E. C. Burke, M. S. Karpeh, K. C. Conlon and M. F. Brennan, “Laparoscopy in the Management of Gastric Adenocarcinoma,” Annals of Surgery, Vol. 225, No. 3, 1997, pp. 262-267. http://dx.doi.org/10.1097/00000658-199703000-00004
[29] P. A. Leake, R. Cardoso, R. Seevaratnam, L. Lourenco, L. Helyer, A. Mahar, C. Law and N. G. Coburn, “A Systematic Review of the Accuracy and Indications for Diagnostic Laparoscopy Prior to Curative-Intent Resection of Gastric Cancer,” Gastric Cancer, Vol. 15 Supplement 1, 2012, pp. S38-S47. http://dx.doi.org/10.1007/s10120-011-0047-z
[30] A. I. Sarela, R. Lefkowitz, M. F. Brennan and M. S. Karpeh, “Selection of Patients with Gastric Adenocarcinoma for Laparoscopic Staging,” The American Journal of Surgery, Vol. 191, No. 1, 2006, pp. 134-138. http://dx.doi.org/10.1016/j.amjsurg.2005.10.015
[31] D. M. D’Ugo, V. Pende, R. Persiani, S. Rausei and A. Picciocchi, “Laparoscopic Staging of Gastric Cancer: An Overview,” Journal of the American College of Surgeons, Vol. 196, No. 6, 2003, pp. 965-974. http://dx.doi.org/10.1016/ S1072-7515(03)00126-1
[32] J. L. Dikken, C. J. van de Velde, D. G. Coit, M. A. Shah, M. Verheij and A. Cats, “Treatment of Resectable Gastric Cancer,” Therapeutic Advances in Gastroenterology, Vol. 5, No. 1, 2012, pp. 49-69. http://dx.doi.org/10.1177/1756283X11410771
[33] T. Nakajima, “Gastric Cancer Treatment Guidelines in Japan,” Gastric Cancer, Vol. 5, No. 1, 2002, pp. 1-5. http://dx.doi.org/10.1007/s101200200000
[34] Y. P. Wang, C. Bennett and T. Pan, “Endoscopic Mucosal Resection for Early Gastric Cancer,” Cochrane Database of Systematic Reviews, No. 1, 2006, Article ID: CD004276.
[35] S. G. Kim, “Endoscopic Treatment for Early Gastric Cancer,” Journal of Gastric Cancer, Vol. 11, No. 3, 2011, pp. 146-154. http://dx.doi.org/10.5230/jgc.2011.11.3.146
[36] T. Gotoda, H. Yamamoto and R. M. Soetikno, “Endoscopic Submucosal Dissection of Early Gastric Cancer,” Journal of Gastroenterology, Vol. 41, No. 10, 2006, pp. 929-942. http://dx.doi.org/10.1007/ s00535-006-1954-3
[37] I. Oda, D. Saito, M. Tada, H. Iishi, S. Tanabe, T. Oyama, T. Doi, Y. Otani, J. Fujisaki, Y. Ajioka, T. Hamada, H. Inoue, T. Gotoda and S. Yoshida, “A Multicenter Retrospective Study of Endoscopic Resection for Early Gastric Cancer,” Gastric Cancer, Vol. 9, No. 4, 2006, pp. 262-270. http://dx.doi.org/10.1007/s10120-006-0389-0
[38] H. H. Hartgrink, E. P. Jansen, N. C. van Grieken and C. J. van de Velde, “Gastric Cancer,” The Lancet, Vol. 374, No. 9688, 2009, pp. 477-490. http://dx.doi.org/10.1016/S0140-6736(09)60617-6
[39] H. Hayashi, T. Ochiai, H. Shimada and Y. Gunji, “Prospective Randomized Study of Open versus LaparoscopyAssisted Distal Gastrectomy with Extraperigastric Lymph Node Dissection for Early Gastric Cancer,” Surgical Endoscopy And Other Interventional Techniques, Vol. 19, No. 9, 2005, pp. 1172-1176. http://dx.doi.org/10.1007/s00464-004-8207-4
[40] C. G. Huscher, A. Mingoli, G. Sgarzini, A. Sansonetti, M. Di Paola, A. Recher and C. Ponzano, “Laparoscopic versus Open Subtotal Gastrectomy for Distal Gastric Cancer: Five-Year Results of a Randomized Prospective Trial,” Annals of Surgery, Vol. 241, No. 2, 2005, pp. 232-237. http://dx.doi.org/10.1097/01.sla. 0000151892.35922.f2
[41] S. Kitano, N. Shiraishi, K. Fujii, K. Yasuda, M. Inomata and Y. Adachi, “A Randomized Controlled Trial Comparing Open vs Laparoscopy-Assisted Distal Gastrectomy for the Treatment of Early Gastric Cancer: An Interim Report,” Surgery, Vol. 131, Suppl. 1, 2002, pp. S306-S311. http://dx.doi.org/10.1067/msy. 2002.120115
[42] J. H. Lee and H. S. Han, “A Prospective Randomized Study Comparing Open vs Laparoscopy-Assisted Distal Gastrectomy in Early Gastric Cancer: Early Results,” Surgical Endoscopy And Other Interventional Techniques, Vol. 19, No. 2, 2005, pp. 168-173. http://dx.doi.org/10.1007/s00464-004-8808-y
[43] J. Cai, D. Wei, C. F. Gao, C. S. Zhang, H. Zhang and T. Zhao, “A Prospective Randomized Study Comparing Open versus Laparoscopy-Assisted D2 Radical Gastrectomy in Advanced Gastric Cancer,” Digestive Surgery, Vol. 28, No. 5-6, 2011, pp. 331-337. http://dx.doi.org/10.1159/000330782
[44] H. H. Kim, W. J. Hyung, G. S. Cho, M. C. Kim, S. U. Han, W. Kim, S. W. Ryu, H. J. Lee and K. Y. Song, “Morbidity and Mortality of Laparoscopic Gastrectomy versus Open Gastrectomy for Gastric Cancer: An Interim Report—A Phase III Multicenter, Prospective, Randomized TRIAL (KLASS Trial),” Annals of Surgery, Vol. 251, No. 3, 2010, pp. 417-420. http://dx.doi.org/10.1097/SLA.0b013e3181cc8f6b
[45] H. Ohtani, Y. Tamamori, K. Noguchi, T. Azuma, S. Fujimoto, H. Oba, T. Aoki, M. Minami and K. Hirakawa, “A Meta-Analysis of Randomized Controlled Trials that Compared Laparoscopy-Assisted and Open Distal Gastrectomy for Early Gastric Cancer,” Journal of Gastrointestinal Surgery, Vol. 14, No. 6, 2010, pp. 958-964. http://dx.doi.org/10.1007/s11605-010-1195-x
[46] J. Sun, J. Li, J. Wang, T. Pan, J. Zhou, X. Fu and S. Zhang, “Meta-Analysis of Randomized Controlled Trials on Laparoscopic Gastrectomy vs Open Gastrectomy for Distal Gastric Cancer,” Hepatogastroenterology, Vol. 59, No. 118, 2012, pp. 1699-1705.
[47] K. Shehzad, K. Mohiuddin, S. Nizami, H. Sharma, I. M. Khan, B. Memon and M. A. Memon, “Current Status of Minimal Access Surgery for Gastric Cancer,” Surgical Oncology, Vol. 16, No. 2, 2007, pp. 85-98. http://dx.doi.org/10.1016/j.suronc.2007.04.012
[48] N. Shiraishi, K. Yasuda and S. Kitano, “Laparoscopic Gastrectomy with Lymph Node Dissection for Gastric Cancer,” Gastric Cancer, Vol. 9, No. 3, 2006, pp. 167-176. http://dx.doi.org/10.1007/s10120-006-0380-9
[49] H. H. Kim, S. U. Han, M. C. Kim, W. J. Hyung, W. Kim, H. J. Lee, S. W. Ryu, G. S. Cho, C. Y. Kim, H. K. Yang, J. Park do, K. Y. Song, S. I. Lee, S. Y. Ryu and J. H. Lee, “Prospective Randomized Controlled Trial (Phase III) to Comparing Laparoscopic Distal Gastrectomy with Open Distal Gastrectomy for Gastric Adenocarcinoma (KLASS 01),” Journal of the Korean Surgical Society, Vol. 84, No. 2, 2013, pp. 123-130. http://dx.doi.org/10.4174/jkss.2013.84.2.123
[50] K. Nakamura, H. Katai, J. Mizusawa, T. Yoshikawa, M. Ando, M. Terashima, S. Ito, M. Takagi, A. Takagane, M. Ninomiya, N. Fukushima and M. Sasako, “A Phase III Study of Laparoscopy-Assisted versus Open Distal Gastrectomy with Nodal Dissection for Clinical Stage IA/IB Gastric Cancer (JCOG0912),” Japanese Journal of Clinical Oncology, Vol. 43, No. 3, 2013, pp. 324-327. http://dx.doi.org/10.1093/jjco/hys220
[51] N. G. Coburn, “Improving Survival for Gastric Cancer Patients—The Role of the Surgeon,” Journal of Clinical Oncology, Vol. 101, No. 2, 2010, pp. 103-104.
[52] K. Maruyama, M. Sasako, T. Kinoshita, T. Sano and H. Katai, “Surgical Treatment for Gastric Cancer: The Japanese Approach,” Seminars in Oncology, Vol. 23, No. 3, 1996, pp. 360-368.
[53] J. Y. An, H. G. Youn, M. G. Choi, J. H. Noh, T. S. Sohn and S. Kim, “The Difficult Choice between Total and Proximal Gastrectomy in Proximal Early Gastric Cancer,” The American Journal of Surgery, Vol. 196, No. 4, 2008, pp. 587-591. http://dx.doi.org/10.1016/j.amjsurg.2007.09.040
[54] F. Bozzetti, E. Marubini, G. Bonfanti, R. Miceli, C. Piano and L. Gennari, “Subtotal versus Total Gastrectomy for Gastric Cancer: Five-Year Survival Rates in a Multicenter Randomized Italian Trial. Italian Gastrointestinal Tumor Study Group,” Annals of Surgery, Vol. 230, No. 2, 1999, pp. 170-178. http://dx.doi.org/10.1097/00000658-199908000-00006
[55] J. L. Gouzi, M. Huguier, P. L. Fagniez, B. Launois, Y. Flamant, F. Lacaine, J. C. Paquet and J. M. Hay, “Total versus Subtotal Gastrectomy for Adenocarcinoma of the Gastric Antrum. A French Prospective Controlled Study,” Annals of Surgery, Vol. 209, No. 2, 1989, pp. 162-166. http://dx.doi.org/10.1097/ 00000658-198902000-00005
[56] S. H. Kim, M. S. Karpeh, D. S. Klimstra, D. Leung and M. F. Brennan, “Effect of Microscopic Resection Line Disease on Gastric Cancer Survival,” Journal of Gastrointestinal Surgery, Vol. 3, No. 1, 1999, pp. 24-33. http://dx.doi.org/10.1016/S1091-255X(99)80004-3
[57] F. Bozzetti, G. Bonfanti, R. Bufalino, V. Menotti, S. Persano, S. Andreola, R. Doci and L. Gennari, “Adequacy of Margins of Resection in Gastrectomy for Cancer,” Annals of Surgery, Vol. 196, No. 6, 1982, pp. 685-690. http://dx.doi.org/10.1097/00000658-198212001-00012
[58] H. R. Raziee, R. Cardoso, R. Seevaratnam, A. Mahar, L. Helyer, C. Law and N. Coburn, “Systematic Review of the Predictors of Positive Margins in Gastric Cancer Surgery and the Effect on Survival,” Gastric Cancer, Vol. 15, Suppl. 1, 2011, pp. S116-S124.
[59] R. C. Martin Jr., D. P. Jaques, M. F. Brennan and M. Karpeh, “Extended Local Resection for Advanced Gastric Cancer: Increased Survival versus Increased Morbidity,” Annals of Surgery, Vol. 236, No. 2, 2002, pp. 159-165. http://dx.doi.org/10.1097/00000658-200208000-00003
[60] J. D. Chen, X. P. Yang, J. G. Shen, W. X. Hu, X. M. Yuan and L. B. Wang, “Prognostic Improvement of Reexcision for Positive Resection Margins in Patients with Advanced Gastric Cancer,” European Journal of Surgical Oncology, Vol. 39, No. 3, 2012, pp. 229-234. http://dx.doi.org/10.1016/j.ejso. 2012.08.004
[61] M. Degiuli, M. Sasako, M. Calgaro, M. Garino, F. Rebecchi, M. Mineccia, D. Scaglione, D. Andreone, A. Ponti and F. Calvo, “Morbidity and Mortality after D1 and D2 Gastrectomy for Cancer: Interim Analysis of the Italian Gastric Cancer Study Group (IGCSG) Randomised Surgical Trial,” European Journal of Surgical Oncology, Vol. 30, No. 3, 2004, pp. 303-308. http://dx.doi.org/10.1016/j.ejso.2003.11.020
[62] F. Pacelli, G. B. Doglietto, R. Bellantone, S. Alfieri, A. Sgadari and F. Crucitti, “Extensive versus Limited Lymph Node Dissection for Gastric Cancer: A Comparative Study of 320 Patients,” British Journal of Surgery, Vol. 80, No. 9, 1993, pp. 1153-1156. http://dx.doi.org/10.1002/bjs.1800800930
[63] A. Sierra, F. M. Regueira, J. L. Hernandez-Lizoain, F. Pardo, M. A. Martinez-Gonzalez and A. C. Javier, “Role of the Extended Lymphadenectomy in Gastric Cancer Surgery: Experience in a Single Institution,” Annals of Surgical Oncology, Vol. 10, No. 3, 2003, pp. 219-226. http://dx.doi.org/10.1245/ASO.2003.07.009
[64] C. M. Volpe, J. Koo, S. M. Miloro, D. L. Driscoll, H. R. Nava and H. O. Douglass Jr., “The Effect of Extended Lymphadenectomy on Survival in Patients with Gastric Adenocarcinoma,” Journal of the American College of Surgeons, Vol. 181, No. 1, 1995, pp. 56-64.
[65] J. J. Bonenkamp, I. Songun, J. Hermans, M. Sasako, K. Welvaart, J. T. Plukker, P. van Elk, H. Obertop, D. J. Gouma, C. W. Taat, et al., “Randomised Comparison of Morbidity after D1 and D2 Dissection for Gastric Cancer in 996 Dutch Patients,” The Lancet, Vol. 345, No. 8952, 1995, pp. 745-748. http://dx.doi.org/10.1016/S0140-6736(95)90637-1
[66] A. Cuschieri, S. Weeden, J. Fielding, J. Bancewicz, J. Craven, V. Joypaul, M. Sydes and P. Fayers, “Patient Survival after D1 and D2 Resections for Gastric Cancer: Long-Term Results of the MRC Randomized Surgical Trial. Surgical Co-Operative Group,” British Journal of Cancer, Vol. 79, No. 9-10, 1999, pp. 1522-1530. http://dx.doi.org/10.1038/sj.bjc.6690243
[67] I. Songun, H. Putter, E. M. Kranenbarg, M. Sasako and C. J. van de Velde, “Surgical Treatment of Gastric Cancer: 15-Year Follow-Up Results of the Randomised Nationwide Dutch D1D2 Trial,” The Lancet Oncology, Vol. 11, No. 5, 2010, pp. 439-449. http://dx.doi.org/10.1016/S1470-2045(10)70070-X
[68] T. Sano, M. Sasako, S. Yamamoto, A. Nashimoto, A. Kurita, M. Hiratsuka, T. Tsujinaka, T. Kinoshita, K. Arai, Y. Yamamura and K. Okajima, “Gastric Cancer Surgery: Morbidity and Mortality Results from a Prospective Randomized Controlled Trial Comparing D2 and Extended Para-Aortic Lymphadenectomy—Japan Clinical Oncology Group Study 9501,” Journal of Clinical Oncology, Vol. 22, No. 14, 2004, pp. 2767-2773. http://dx.doi.org/10.1200/JCO.2004.10.184
[69] M. Sasako, T. Sano, S. Yamamoto, Y. Kurokawa, A. Nashimoto, A. Kurita, M. Hiratsuka, T. Tsujinaka, T. Kinoshita, K. Arai, Y. Yamamura and K. Okajima, “D2 Lymphadenectomy Alone or with Para-Aortic Nodal Dissection for Gastric Cancer,” The New England Journal of Medicine, Vol. 359, No. 5, 2008, pp. 453-462. http://dx.doi.org/10.1056/NEJMoa0707035
[70] N. N. Baxter and T. M. Tuttle, “Inadequacy of Lymph Node Staging in Gastric Cancer Patients: A PopulationBased Study,” Annals of Surgical Oncology, Vol. 12, No. 12, 2005, pp. 981-987. http://dx.doi.org/10.1245/ASO.2005.03.008
[71] N. G. Coburn, C. J. Swallow, A. Kiss and C. Law, “Significant Regional Variation in Adequacy of Lymph Node Assessment and Survival in Gastric Cancer,” Cancer, Vol. 107, No. 9, 2006, pp. 2143-2151. http://dx.doi.org/10.1002/cncr.22229
[72] S. A. Hundahl, J. L. Phillips and H. R. Menck, “The National Cancer Data Base Report on Poor Survival of U.S. Gastric Carcinoma Patients Treated With Gastrectomy: Fifth Edition American Joint Committee on Cancer Staging, Proximal disease, and the ‘Different Disease’ Hypothesis,” Cancer, Vol. 88, No. 4, 2000, pp. 921-932.
[73] K. C. Peeters, S. A. Hundahl, E. K. Kranenbarg, H. Hartgrink and C. J. van de Velde, “Low Maruyama Index Surgery for Gastric Cancer: Blinded Reanalysis of the Dutch D1-D2 Trial,” World Journal of Surgery, Vol. 29, No. 12, 2005, pp. 1576-1584. http://dx.doi.org/10.1007/s00268-005-7907-9
[74] J. Fujita, Y. Kurokawa, T. Sugimoto, I. Miyashiro, S. Iijima, Y. Kimura, S. Takiguchi, Y. Fujiwara, M. Mori and Y. Doki, “Survival Benefit of Bursectomy in Patients with Resectable Gastric Cancer: Interim Analysis Results of a Randomized Controlled Trial,” Gastric Cancer, Vol. 15, No. 1, 2012, pp. 42-48. http://dx.doi.org/10.1007/s10120-011-0058-9
[75] A. L. Mahar, N. G. Coburn, P. J. Karanicolas, R. Viola and L. K. Helyer, “Effective Palliation and Quality of Life Outcomes in Studies of Surgery for Advanced, NonCurative Gastric Cancer: A Systematic Review,” Gastric Cancer, Vol. 15, Suppl. 1, 2011, pp. S138-S145.
[76] A. L. Mahar, N. G. Coburn, S. Singh, C. Law and L. K. Helyer, “A Systematic Review of Surgery for Non-Curative Gastric Cancer,” Gastric Cancer, Vol. 15, Suppl. 1, 2012, pp. S125-S137.
[77] K. Fujitani, H. K. Yang, Y. Kurokawa, J. Park do, T. Tsujinaka, B. J. Park, H. Fukuda, S. H. Noh, N. Boku, Y. J. Bang, M. Sasako and J. I. Lee, “Randomized Controlled Trial Comparing Gastrectomy plus Chemotherapy with Chemotherapy Alone in Advanced Gastric Cancer with a Single Non-Curable Factor: Japan Clinical Oncology Group Study JCOG 0705 and Korea Gastric Cancer Association Study KGCA01,” Japanese Journal of Clinical Oncology, Vol. 38, No. 7, 2008, pp. 504-506. http://dx.doi.org/ 10.1093/jjco/hyn058
[78] S. P. Kerkar, C. D. Kemp, A. Duffy, U. S. Kammula, D. S. Schrump, K. F. Kwong, M. Quezado, B. R. Goldspiel, A. Venkatesan, A. Berger, M. Walker, M. A. Toomey, S. M. Steinberg, G. Giaccone, S. A. Rosenberg and I. Avital, “The GYMSSA Trial: A Prospective Randomized Trial Comparing Gastrectomy, Metastasectomy plus Systemic Therapy versus Systemic Therapy Alone,” Trials, Vol. 10, No. 121, 2009, p. 121.
[79] R. Swan and T. J. Miner, “Current Role of Surgical Therapy in Gastric Cancer,” World Journal of Gastroenterology, Vol. 12, No. 3, 2006, pp. 372-379.
[80] J. S. Macdonald, “Gastric Cancer—New Therapeutic Options,” The New England Journal of Medicine, Vol. 355, No. 1, 2006, pp. 76-77. http://dx.doi.org/10.1056/NEJMe068121
[81] J. S. Macdonald, S. R. Smalley, J. Benedetti, S. A. Hundahl, N. C. Estes, G. N. Stemmermann, D. G. Haller, J. A. Ajani, L. L. Gunderson, J. M. Jessup and J. A. Martenson, “Chemoradiotherapy after Surgery Compared with Surgery Alone for Adenocarcinoma of the Stomach or Gastroesophageal Junction,” The New England Journal of Medicine, Vol. 345, No. 10, 2001, pp. 725-730. http://dx.doi.org/10.1056/ NEJMoa010187
[82] D. Cunningham, W. H. Allum, S. P. Stenning, J. N. Thompson, C. J. Van de Velde, M. Nicolson, J. H. Scarffe, F. J. Lofts, S. J. Falk, T. J. Iveson, D. B. Smith, R. E. Langley, M. Verma, S. Weeden, Y. J. Chua and M. T. Participants, “Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer,” The New England Journal of Medicine, Vol. 355, No. 1, 2006, pp. 11-20. http://dx.doi.org/10.1056/NEJMoa055531
[83] X. Paoletti, K. Oba, T. Burzykowski, S. Michiels, Y. Ohashi, J. P. Pignon, P. Rougier, J. Sakamoto, D. Sargent, M. Sasako, E. Van Cutsem and M. Buyse, “Benefit of Adjuvant Chemotherapy for Resectable Gastric Cancer: A Meta-Analysis,” The Journal of the American Medical Association, Vol. 303, No. 17, 2010, pp. 1729-1737. http://dx.doi.org/10.1001/jama.2010.534
[84] D. Takahari, T. Hamaguchi, K. Yoshimura, H. Katai, S. Ito, N. Fuse, M. Konishi, H. Yasui, M. Terashima, M. Goto, N. Tanigawa, K. Shirao, T. Sano and M. Sasako, “Survival Analysis of Adjuvant Chemotherapy with S-1 plus Cisplatin for Stage III Gastric Cancer,” Gastric Cancer, Epub Ahead of Print, 2013.
[85] Y. J. Bang, Y. W. Kim, H. K. Yang, H. C. Chung, Y. K. Park, K. H. Lee, K. W. Lee, Y. H. Kim, S. I. Noh, J. Y. Cho, Y. J. Mok, J. Ji, T. S. Yeh, P. Button, F. Sirzen and S. H. Noh, “Adjuvant Capecitabine and Oxaliplatin for Gastric Cancer after D2 Gastrectomy (CLASSIC): A Phase 3 Open-Label, Randomised Controlled Trial,” The Lancet, Vol. 379, No. 9813, 2012, pp. 315-321. http://dx.doi.org/10.1016/ S0140-6736(11)61873-4
[86] T. Sano, “Adjuvant and Neoadjuvant Therapy of Gastric Cancer: A Comparison of Three Pivotal Studies,” Current Oncology Reports, Vol. 10, No. 3, 2008, pp. 191-198. http://dx.doi.org/10.1007/ s11912-008-0030-y

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.