Precision surgical approach with lymph-node dissection in early gastric cancer
| Autor: | Shinichi Kinami, Hideto Fujita, Takashi Miyata, Yasuto Tomita, Takeo Kosaka, Naohiko Nakamura, Nobuhiko Ueda |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Endoscopic Mucosal Resection medicine.medical_treatment Review Metastasis 03 medical and health sciences 0302 clinical medicine Gastrectomy Stomach Neoplasms Biopsy medicine Humans Lymph node Pylorus Neoplasm Staging medicine.diagnostic_test Sentinel Lymph Node Biopsy business.industry Recovery of function Gastroenterology Cardia General Medicine Perioperative Sentinel node Prognosis Sentinel lymph node surgery medicine.disease Surgery Early Gastric Cancer Dissection Treatment Outcome medicine.anatomical_structure Stomach neoplasms surgery Lymphatic Metastasis Gastrectomy methods 030220 oncology & carcinogenesis Quality of Life Lymph Node Excision 030211 gastroenterology & hepatology Gastric cancer business Organ Sparing Treatments |
| Zdroj: | World Journal of Gastroenterology |
| ISSN: | 1007-9327 |
| DOI: | 10.3748/wjg.v25.i14.1640 |
| Popis: | The gravest prognostic factor in early gastric cancer is lymph-node metastasis, with an incidence of about 10% overall. About two-thirds of early gastric cancer patients can be diagnosed as node-negative prior to treatment based on clinic-pathological data. Thus, the tumor can be resected by endoscopic submucosal dissection. In the remaining third, surgical resection is necessary because of the possibility of nodal metastasis. Nevertheless, almost all patients can be cured by gastrectomy with D1+ lymph-node dissection. Laparoscopic or robotic gastrectomy has become widespread in East Asia because perioperative and oncological safety are similar to open surgery. However, after D1+ gastrectomy, functional symptoms may still result. Physicians must strive to minimize post-gastrectomy symptoms and optimize long-term quality of life after this operation. Depending on the location and size of the primary lesion, preservation of the pylorus or cardia should be considered. In addition, the extent of lymph-node dissection can be individualized, and significant gastric-volume preservation can be achieved if sentinel node biopsy is used to distinguish node-negative patients. Though the surgical treatment for early gastric cancer may be less radical than in the past, the operative method itself seems to be still in transition. |
| Databáze: | OpenAIRE |
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