Radical gastric cancer surgery is the primary treatment for gastric cancer. Radical surgery for gastric cancer means surgery that removes the primary tumor, regional lymph nodes, and infiltrated tissue together, leaving no tumor remaining, and thus potentially curing the cancer. Patients may hear the similar description of “surgical cure level A”, what does it mean? In this article, we will take you through the grading of radical surgery for gastric cancer.
There are three levels of radical gastric cancer surgery based on the degree of cure
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There are three levels of radical surgery for gastric cancer, based on the extent of surgically cleared lymph nodes (D) compared with the extent of actual lymph node metastases (N).
Grade A D > N, that is, the extent of surgically cleared lymph nodes is greater than the extent of metastatic lymph nodes, and pathologic examination of the surgical specimen indicates no cancer cells within 1 cm of the incisional margin. grade A is the highest level of cure.
Grade B
Grade B D = N, in which the extent of surgical lymph node clearance equals the extent of metastatic lymph nodes or pathology reveals cancer infiltration within 1 cm of the surgical specimen’s margin. grade B is also a radical procedure, but less radical than grade A.
Grade C the surgery removed only the lesion and part of the metastasis in the stomach, i.e., there was cancer infiltration at the margin or metastatic lymph nodes, and other metastases remained in the body.
How do doctors determine the extent of cure?
One of the hallmarks of cancer is metastasis, and the main route of metastasis in gastric cancer is lymph node metastasis. The regional lymph nodes around the stomach are divided into 3 stations, depending on the distance from the stomach. The lymph node metastasis of gastric cancer is usually gradual, “station by station,” but jumping lymph node metastasis can also occur, in which the first station is not metastasized but jumps to the second station.
In principle, the cleaner the lymph nodes that are likely to metastasize, the better. However, in clinical practice, as more lymph nodes are removed, the complexity of the surgery increases, and the demands on the patient’s physical status and ability to tolerate it also increase. Therefore, depending on the patient’s specific situation, the surgeon will strive to perform radical surgery with grade A criteria when conditions permit to improve outcomes.