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The Role of Surgery in Management of Gastric Cancer

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Cancer Metastasis Through the Lymphovascular System

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Abstract

Gastric adenocarcinoma is an aggressive tumor with significant global burden. Incidence is decreasing in Western countries but gastric cancer remains a major cause of cancer death in East Asian and developing countries. Gastric adenocarcinomas have been historically subdivided according to dominant histology by the Lauren classification into gland-forming intestinal-type lesions and infiltrative, non-gland forming diffuse-type lesions. Loss of E-cadherin expression encoded by the CDH1 gene plays a major role in carcinogenesis of diffuse-type cancers while Helicobacter pylori infection contributes to intestinal-type cancers. Gastric adenocarcinoma has a proclivity for early invasion into lymphatic channels with rates of lymph node involvement in the range of 20–30% with submucosal or deeper involvement by the primary tumor. Adequate lymphadenectomy in potentially resectable cases has therefore been a topic of substantial study. A surgical approach accounting for the typical lymphatic drainage of gastric tumors has been well described by Japanese surgeons and D2 lymphadenectomy, encompassing surgical clearance of the extended regional basin, has increasingly been adopted worldwide. Multimodal therapy plays an important role in clinical stage II–III cancers, with perioperative chemotherapy gaining momentum in recent years following the publication of randomized trial data supporting this approach. The role of adjuvant chemoradiotherapy compared to adjuvant chemotherapy alone remains a subject of controversy. Therapy directed at the HER2 receptor and the programmed death receptor immune checkpoint pathway are under active investigation and show promise for appropriately selected patients.

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Authors and Affiliations

  1. Moffitt Cancer Center, Tampa, FL, USA

    Andrew J. Sinnamon & Jose M. Pimiento

  2. University of Pennsylvania, Philadelphia, PA, USA

    Robert E. Roses

Authors
  1. Andrew J. Sinnamon
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  2. Jose M. Pimiento
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  3. Robert E. Roses
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Correspondence to Robert E. Roses .

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Editors and Affiliations

  1. Department of Surgery and Melanoma Center, California Pacific Medical Center and Research Institute, San Francisco, CA, USA

    Stanley P. Leong

  2. Henry Ford Cancer Institute, Detroit, MI, USA

    S. David Nathanson

  3. Moffitt Cancer Center, Tampa, FL, USA

    Jonathan S. Zager

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Sinnamon, A.J., Pimiento, J.M., Roses, R.E. (2022). The Role of Surgery in Management of Gastric Cancer. In: Leong, S.P., Nathanson, S.D., Zager, J.S. (eds) Cancer Metastasis Through the Lymphovascular System. Springer, Cham. https://doi.org/10.1007/978-3-030-93084-4_39

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