Radical gastric cancer surgery is the primary treatment for gastric cancer and the only way to cure it. The term “standard radical surgery” may come up in the process of learning about the procedure for patients with gastric cancer. What does standard radical surgery mean? Is a procedure that is not called standard radical surgery “not standard”? Are you a candidate for standard radical surgery or a “non-standard” radical surgery? This article will answer these questions.
What types of gastric cancer should undergo “standard radical surgery”?
Which gastric cancers are subject to “standard radical surgery”?
Standard radical surgery for gastric cancer refers to D2 radical surgery, which is the complete removal of the primary tumor in the stomach along with the removal of all of the lymph nodes at station 2.
Although it is called the “standard,” standard radical surgery for gastric cancer is not used for all patients, but mainly for progressive gastric cancer or early gastric cancer with lymph node metastases, that is, tumors that have infiltrated deeper than the submucosa (muscular layer or above) or with lymph node metastases that have not yet invaded adjacent organs.
Is resection less extensive than standard radical surgery also “standard” treatment?
What is the “standard” treatment?
For some gastric cancers, it is common for doctors to perform procedures that are not standard radical surgery. Although the extent of resection is less than standard radical surgery, these surgical treatments that are not called “standard radical surgery” are the best treatment options for the patient’s condition.
- For early-stage gastric cancer without lymph node metastases, physicians generally choose to perform only an endoscopic local excision or a D1 radical procedure, which involves removing the gastric lesion while clearing the lymph nodes to station 1. These patients generally do not require further treatment after surgery, but are followed up regularly.
- Some gastric cancers are lost to radical surgery because of extensive local infiltration, peritoneal dissemination, and distant metastases. If accompanied by complications such as bleeding, perforation or obstruction, physicians usually choose to perform palliative surgery, including palliative gastrectomy, gastrojejunostomy, gastrostomy, and jejunostomy, when the patient’s systemic condition allows. Palliative surgery can improve patients’ quality of life, reduce tumor load and help prolong survival, but the average survival time after surgery is only 8-12 months, and is often accompanied by a high complication rate and surgical mortality. Therefore, physicians will choose carefully.
- For some early gastric cancers, doctors may also consider function-preserving reduction surgery, such as distal gastrectomy with preservation of the pylorus and gastric wedge resection. However, the role of such procedures remains to be further validated.
In conclusion, the appropriateness of a surgical approach for a patient is not based on the presence or absence of the word “standard” in the name of the procedure. Standard radical surgery is not suitable for all patients with gastric cancer, and the surgeon will choose a treatment plan that is individualized to the patient to achieve the best possible outcome.