[Treatment of gastric cancer beyond current guideline: state of the art]

Chirurg. 2013 Apr;84(4):310-5. doi: 10.1007/s00104-012-2454-z.
[Article in German]

Abstract

The majority of recommendations in the current S3 guideline on the diagnosis and treatment of gastric carcinoma are based on good clinical practice and lack supporting randomized studies. With the development of endoscopic resection and multimodal treatment concepts, pretherapeutic tumor staging has gained in importance. However, the accuracy of present imaging modalities is still limited with a tendency towards overstaging of locally advanced tumors. Extended lymph node dissection cannot be recommended in cases with advanced lymph node involvement. In cardiac cancer retroperitoneal lymphatic spread to the left renal vein is an early event and should thus not be classified as stage IV disease. In cases of intra-abdominal gastrectomy a pouch reconstruction should be considered in cases with a good overall prognosis. Subgroup analyses indicate a differential therapeutic effect of the established perioperative chemotherapy depending on the location of the primary tumor. There is also good evidence for an additional beneficial effect of radiotherapy in combination with chemotherapy.

Publication types

  • English Abstract
  • Review

MeSH terms

  • Chemotherapy, Adjuvant
  • Combined Modality Therapy
  • Endosonography
  • Evidence-Based Medicine
  • Gastrectomy / methods*
  • Germany
  • Guideline Adherence*
  • Humans
  • Intestine, Small / surgery
  • Lymph Node Excision
  • Lymphatic Metastasis / pathology
  • Neoplasm Staging
  • Plastic Surgery Procedures / methods
  • Randomized Controlled Trials as Topic
  • Stomach Neoplasms / drug therapy
  • Stomach Neoplasms / pathology
  • Stomach Neoplasms / surgery*
  • Survival Rate
  • Tomography, X-Ray Computed