Surgery for Gastric Cancer: State of the Art

Surgery remains the undisputed mainstay in the management of gastric cancer, and advances in chemotherapy and radiation have improved outcomes in patients with resectable disease. A multidisciplinary approach, with active coordination across specialties dealing with management of gastric cancers provides improved quality of care and outcomes. Radical gastrectomy involves complete removal of tumor with adequate margins and appropriate lymph node dissection. Spleen preserving D2 lymphadenectomy is the present standard of care for all resectable tumors except few early tumors (T1a lesions) where endoscopic or local resections are deemed suitable. Perioperative or adjuvant chemotherapy should be offered to all patients with resectable tumor, having advanced T stage or node-positive disease. In patients with advanced tumors with invasion of adjacent organs, multivisceral resections can be offered selectively in the presence of good performance status and response to chemotherapy, which can lead to improvement in overall survival. The role of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy needs to be evaluated in patients with limited peritoneal disease.