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World J Gastroenterol. Oct 14, 2014; 20(38): 13667-13680
Published online Oct 14, 2014. doi: 10.3748/wjg.v20.i38.13667
Subtotal gastrectomy for gastric cancer
Roberto Santoro, Giuseppe Maria Ettorre, Eugenio Santoro
Roberto Santoro, Eugenio Santoro, Giuseppe M Ettorre, Department of General Surgery and Transplantation, San Camillo-Forlanini General Hospital, 00152 Rome, Italy
Author contributions: The idea was proposed by Santoro R; Santoro R and Ettorre GM drafted the initial manuscript; Santoro E reviewed and edited the draft; all authors approved the final manuscript before submission.
Correspondence to: Roberto Santoro, MD, PhD, Department of General Surgery and Transplantation, San Camillo-Forlanini General Hospital, Circ Gianicolense 87, 00152 Rome, Italy. santoro_roberto@fastwebnet.it
Telephone: +39-6-58705408 Fax: +39-6-58704719
Received: October 28, 2013
Revised: June 10, 2014
Accepted: June 26, 2014
Published online: October 14, 2014
Processing time: 353 Days and 8.5 Hours
Abstract

Although a steady decline in the incidence and mortality rates of gastric carcinoma has been observed in the last century worldwide, the absolute number of new cases/year is increasing because of the aging of the population. So far, surgical resection with curative intent has been the only treatment providing hope for cure; therefore, gastric cancer surgery has become a specialized field in digestive surgery. Gastrectomy with lymph node (LN) dissection for cancer patients remains a challenging procedure which requires skilled, well-trained surgeons who are very familiar with the fast-evolving oncological principles of gastric cancer surgery. As a matter of fact, the extent of gastric resection and LN dissection depends on the size of the disease and gastric cancer surgery has become a patient and “disease-tailored” surgery, ranging from endoscopic resection to laparoscopic assisted gastrectomy and conventional extended multivisceral resections. LN metastases are the most important prognostic factor in patients that undergo curative resection. LN dissection remains the most challenging part of the operation due to the location of LN stations around major retroperitoneal vessels and adjacent organs, which are not routinely included in the resected specimen and need to be preserved in order to avoid dangerous intra- and postoperative complications. Hence, the surgeon is the most important non-TMN prognostic factor in gastric cancer. Subtotal gastrectomy is the treatment of choice for middle and distal-third gastric cancer as it provides similar survival rates and better functional outcome compared to total gastrectomy, especially in early-stage disease with favorable prognosis. Nonetheless, the resection range for middle-third gastric cancer cases and the extent of LN dissection at early stages remains controversial. Due to the necessity of a more extended procedure at advanced stages and the trend for more conservative treatments in early gastric cancer, the indication for conventional subtotal gastrectomy depends on multiple variables. This review aims to clarify and define the actual landmarks of this procedure and the role it plays compared to the whole range of new and old treatment methods.

Keywords: Gastric cancer; Gastrectomy; Lymphadenectomy; Laparoscopy; Endoscopy; Quality of life; Gastric stump cancer

Core tip: Gastric cancer surgical resection with curative intent is the only treatment providing hope for cure. Gastrectomy with lymph node dissection remains a challenging procedure, which should abide by well-defined oncological principles. Subtotal gastrectomy is the treatment of choice for middle and distal-third gastric cancer; however, due to the necessity of a more extended procedure at advanced stages and the trend for more conservative treatments in early gastric cancer, the indication for conventional subtotal gastrectomy depends on multiple variables. This review aims to define the actual landmarks of this procedure and the role it plays compared to the whole range of new and old treatment methods.