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Surgical Oncology

Surgical Management of Gastric Cancer

Comprehensive surgical approaches and techniques for gastric cancer treatment. Preoperative evaluation, surgical procedures, and postoperative care.

GSK Clinical Team
2025
GSK Clinical Research

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Overview

Gastric cancer remains a significant global health challenge. Surgical resection is the cornerstone of curative treatment, with outcomes dependent on proper patient selection, surgical technique, and comprehensive perioperative care.

Surgical Principles:

  • Complete tumor resection with negative margins
  • Adequate lymph node dissection
  • Preservation of organ function when possible
  • Minimization of surgical morbidity
  • Multidisciplinary approach to care

Preoperative Evaluation

Staging Assessment

Imaging Studies

  • • CT scan with contrast
  • • Endoscopic ultrasound (EUS)
  • • PET-CT scan
  • • MRI imaging
  • • Laparoscopic staging

Laboratory Tests

  • • Complete blood count
  • • Comprehensive metabolic panel
  • • Tumor markers (CEA, CA 19-9)
  • • Nutritional assessment
  • • Cardiac evaluation

Patient Selection Criteria

  • • Resectable disease without distant metastasis
  • • Adequate performance status (ECOG 0-2)
  • • Acceptable cardiac and pulmonary function
  • • Nutritional optimization when possible
  • • Patient understanding and consent

Surgical Approaches

Open Surgery

  • Total Gastrectomy

    Complete removal of stomach with reconstruction

  • Subtotal Gastrectomy

    Partial gastric resection preserving gastric function

  • Extended Resection

    Including adjacent organs when involved

Minimally Invasive Surgery

  • Laparoscopic Gastrectomy

    Reduced morbidity with comparable oncologic outcomes

  • Robotic-Assisted Surgery

    Enhanced precision and visualization

  • Hybrid Approaches

    Combining laparoscopic and open techniques

Lymph Node Dissection

D1 vs D2 Dissection

D1 Dissection

  • • Perigastric lymph nodes only
  • • Less extensive procedure
  • • Lower morbidity
  • • May be appropriate for early-stage disease

D2 Dissection

  • • Perigastric + regional lymph nodes
  • • More comprehensive staging
  • • Better oncologic outcomes
  • • Standard for advanced disease

Lymph Node Stations

  • • Station 1-6: Perigastric nodes
  • • Station 7-11: Regional nodes
  • • Station 12-16: Distant nodes
  • • Minimum 15 nodes recommended

Sentinel Node Mapping

  • • Emerging technique for early-stage disease
  • • Reduced morbidity
  • • Requires specialized expertise
  • • Still investigational

Reconstruction Techniques

After Total Gastrectomy

  • • Roux-en-Y esophagojejunostomy
  • • Jejunal pouch reconstruction
  • • Double tract reconstruction
  • • Jejunal interposition

After Subtotal Gastrectomy

  • • Billroth I reconstruction
  • • Billroth II reconstruction
  • • Roux-en-Y gastrojejunostomy
  • • Jejunal interposition

Perioperative Care

Enhanced Recovery After Surgery (ERAS)

Preoperative

  • • Patient education
  • • Nutritional optimization
  • • Prehabilitation
  • • Smoking cessation

Intraoperative

  • • Minimally invasive techniques
  • • Optimal pain management
  • • Fluid management
  • • Normothermia maintenance

Postoperative

  • • Early mobilization
  • • Early enteral nutrition
  • • Multimodal analgesia
  • • Discharge planning

Complications Management

  • • Anastomotic leak
  • • Bleeding
  • • Infection
  • • Dumping syndrome
  • • Nutritional deficiencies

Quality Metrics

  • • 30-day mortality
  • • Readmission rates
  • • Complication rates
  • • Length of stay
  • • Patient satisfaction

Outcomes & Prognosis

Survival Outcomes

60-80%
5-year survival (Stage I)
30-50%
5-year survival (Stage II)
10-30%
5-year survival (Stage III)

Prognostic Factors

  • • Tumor stage (TNM)
  • • Lymph node involvement
  • • Surgical margin status
  • • Histologic grade
  • • Patient performance status

Quality of Life

  • • Nutritional status
  • • Eating function
  • • Gastrointestinal symptoms
  • • Psychological well-being
  • • Social functioning

Key Takeaways

Summary Points:

  • Surgical resection remains the cornerstone of curative treatment
  • Proper staging and patient selection are crucial for outcomes
  • D2 lymph node dissection improves survival in advanced disease
  • Minimally invasive techniques reduce morbidity without compromising oncologic outcomes
  • ERAS protocols improve recovery and reduce complications
  • Multidisciplinary approach ensures optimal patient care