Carcinoma of stomach is one of the common malignant tumors in China, and the mortality rate is the highest among malignant tumors, mostly seen in men, and the ratio of men to women is about 2:1.
The treatment of gastric cancer is a comprehensive treatment mainly based on surgery, and the most effective method to achieve the purpose of cure is surgical resection. Surgical treatment should follow three requirements: 1) full removal of primary focus; 2) complete removal of perigastric lymph nodes; 3) complete elimination of free cancer cells and micro tissues in abdominal cavity. Surgery includes radical surgery and palliative surgery for gastric cancer. We believe that for patients who are physically fit and do not have obvious distant metastasis, they should be investigated surgically and strive for radical resection; even if radical resection cannot be achieved, the less tumor tissue remains, the better, so as to create favorable conditions for other non-surgical treatment methods and achieve the purpose of reasonable comprehensive treatment. Xie Jianguo, Department of General Surgery, Henan Cancer Hospital
The surgical treatment of gastric cancer has a long history, as early as in the 1830s billroth, polya and other great medical doctors started the surgery of stomach, and the current surgical method has tended to be stereotyped, generally considered as two parts of enlarged surgery and reduced surgery. Expanded resection can improve the radicality and perform whole stomach and combined organ resection for cancerous tissue invading the organs around the stomach; for early gastric cancer, avoid and control unnecessary expanded resection, and perform local resection, such as endoscopic series of treatment, such as polyp-like early cancer resection, and pancreatic surgery for preservation. Rational radical surgery for gastric cancer is an important topic in current research, and there are differences between Eastern and Western countries in terms of specific mastery of indications for enlargement and reduction surgery. With the continuous improvement of anesthesiology, blood transfusion, rehydration, antimicrobial agents and surgical equipment and technology, the safety of surgical treatment has been significantly improved and the mortality rate has been significantly reduced.
The most important thing for surgeons to master the scale and principles of surgery is to determine the extent of resection according to the depth of invasion of the primary lesion of gastric cancer into the gastric wall and the extent of infiltration of the surrounding tissues and organs outside the gastric wall, and to determine the extent of removal according to the extent of regional lymph node metastasis; different sites, types and biological characteristics of gastric cancer have different infiltration distances up and down the gastric wall. For example, the infiltration distance of pyloric sinus cancer to the duodenal side, and the infiltration distance of cardia cancer of gastric fundus to the esophagus, to determine major gastrectomy, near total gastrectomy or total gastrectomy, have been followed.
Palliative resection: There are different opinions on the attitude of surgical resection for more advanced gastric cancer, especially for stage IV patients. At present, the early diagnosis rate of gastric cancer in China is low, and stage IV gastric cancer is a considerable part of all hospitalized patients, so whether the treatment method for this part of patients is appropriate or not directly affects the expected efficacy of all gastric cancer. Data show that whether it is a simple dissection or various short-circuit surgery, the survival rate is roughly similar to that of the untreated group because the primary lesion is not removed, which cannot fundamentally change the natural survival curve of gastric cancer, while the 5-year survival rate of palliative resection can reach 3.18%-11.70% in some cases. Therefore, the estimation of the extent of metastasis during surgery is often greater than the actual one, so that some resections which are clinically considered as palliative may have actually achieved the purpose of radical cure; when there are clear metastases beyond the resectable range, it is also beneficial to relieve the symptoms, reduce the patient’s cancer load and use other comprehensive therapies such as chemotherapy, radiotherapy and immunotherapy. Therefore, except for palliative total gastrectomy which should be treated with caution, as long as the patient’s systemic condition permits and the local lesion conditions allow, we should actively strive to remove the primary lesion and the resectable metastases.