Improving the outcomes in gastric cancer surgery
Gastric cancer remains a significant health problem worldwide and surgery is currently the only potentially curative treatment option. Gastric cancer surgery is generally considered to be high risk surgery and fiveyear survival rates are poor,therefore a continuous strive to improve outcomes for the...
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Published in | World journal of gastroenterology : WJG Vol. 20; no. 38; pp. 13692 - 13704 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Baishideng Publishing Group Inc
14.10.2014
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Subjects | |
Online Access | Get full text |
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Summary: | Gastric cancer remains a significant health problem worldwide and surgery is currently the only potentially curative treatment option. Gastric cancer surgery is generally considered to be high risk surgery and fiveyear survival rates are poor,therefore a continuous strive to improve outcomes for these patients is warranted. Fortunately,in the last decades several potential advances have been introduced that intervene at various stages of the treatment process. This review provides an overview of methods implemented in pre-,intra- and postoperative stage of gastric cancer surgery to improve outcome. Better preoperative risk assessment using comorbidity index(e.g.,Charlson comorbidity index),assessment of nutritional status(e.g.,short nutritional assessment questionnaire,nutritional risk screening- 2002) and frailty assessment(Groningen frailty indicator,Edmonton frail scale,Hopkins frailty) was introduced. Also preoperative optimization of patients using prehabilitation has future potential.Implementation of fast-track or enhanced recovery after surgery programs is showing promising results,although future studies have to determine what the exact optimal strategy is.Introduction of laparoscopic surgery has shown improvement of results as well as optimization of lymph node dissection.Hyperthermic intraperitoneal chemotherapy has not shown to be beneficial in peritoneal metastatic disease thus far.Advances in postoperative care include optimal timing of oral diet,which has been shown to reduce hospital stay.In general,hospital volume,i.e.,centralization,and clinical audits might further improve the outcome in gastric cancer surgery.In conclusion,progress has been made in improving the surgical treatment of gastric cancer.However,gastric cancer treatment is high risk surgery and many areas for future research remain. |
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Bibliography: | Juul JW Tegels;Michiel FG De Maat;Karel WE Hulsewé;Anton GM Hoofwijk;Jan HMB Stoot;Department of Surgery,Orbis Medical Center;Department of Surgery,Maastricht University Medical Center;Department of Surgery,Atrium Medical Center ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1 Author contributions: Stoot JHMB was invited and designed the outline of the paper; Tegels JJW wrote the first and final draft of the paper; De Maat MFG, Hulsewé KWE, Hoofwijk AGM and Stoot JHMB made writing contributions and extensively reviewed the manuscript. Correspondence to: Juul JW Tegels, MD, Department of Surgery, Orbis Medical Centre, PO Box 5500, 6130 MB Sittard, The Netherlands. ju.tegels@orbisconcern.nl Telephone: +31-88-4597777 Fax: +31-88-4597975 |
ISSN: | 1007-9327 2219-2840 |
DOI: | 10.3748/wjg.v20.i38.13692 |