Gastric cancer surgery: can east meet west?

摘要

Gastric cancer incidence has been falling in the Western countries in the past several years. However, this is not true in most parts of Asia. In a recently published age-standardized world cancer incidence by the UK cancer research in June 2010, East Asian countries (China, Japan, Korea and Mongolia) reported rates of 46 per 100,000 for men and 21 per 100,000 for women. These numbers are twice the world average [1]. This phenomenon makes gastric cancer the second-leading killer worldwide, next only to lung cancer. Gastric cancers are lethal because of late diagnosis. Compounding this problem is the lack of curative adjuvant therapy. Consequently, surgery is often the first and last defense of the patient [2]. Unfortunately, even this simple "solution" is plagued by disagreement among surgeons: should we do total or subtotal gastrectomies? Should we do splenectomy? Should we take out all lymph nodes? The most contentious of these has to do with the extent of lymph node dissection. Citing Level 1 evidence that shows no survival benefit with extensive lymph node dissection [3,4], most Western surgeons presently remove all involved lymph nodes but refrain from doing systematic lymph node dissection. The Japanese, on the other hand, have retrospective data that show superior survival rates in patients who underwent Dl, D2 and D3 dissection. In this issue of Journal of Surgical Oncology, Jiang Cheng-Gang and his cohorts from the First Affiliated Hospital of China Medical University in Shenyang, Liaoning, China, present their series of 1,201 gastric cancer patients.