R-0 RESECTION FOR GASTRIC CANCER

Abstract

To date the basic guidelines in surgical oncology of the stomach may be summarized in the correct definition of “R0” exeresis (curative operation), but there is still much debate on which should practically be the extension of the gastric resection and which the kind of lymphatic dissection in order to fulfill all the criteria for a correct definition of “curative surgery”. As regards the T factor, almost all Authors agree on the fact the a correct R0 gastric resection must include a tumor-free distal margin at least 6 cm from the superior edge of the neoplasm; a safe distal margin should be at least at 1 cm. below the pylorus. Provided that these principles are thoroughly observed, there is no oncologic advantage in performing a total gastrectomy instead of a sub-total gastric resection. Differently, as regards the N factor, there is no agreement on which kind of lymph nodal dissection should be routinely adopted: published reports on this subject are somewhat controversial and also where as a systematic extended lymphadenectomy showed a possible statistical benefit in long term survival, unacceptable morbidity rates discourage a diffuse application of extended lymphatic dissection out of dedicated; institutions. Anyhow, at the moment it is almost universally accepted that a mini mum of 25 removed nodes are necessary for a correct and comparable staging of gastric cancer.

At last, literature data do not support the routine use of splenectomy, with the only exception of those cases with documented lymph nodal enlargement at the splenichilum.