636 Does extensive surgery improve survival in gastric cancer?

Abstract

Experiences from Japan with extensive lymph node removal and much better survival as compared with the results following surgical therapy as it is conventionally performed in Europe has been put forward to support a more aggressive surgical approach to patients with gastric cancer. On the other hand, it has been argued that cancer with spread to distant lymph nodes is unlikely to be cured with techniques that only can provide local cancer control. Furthermore, previous trials from the western world have not been able to support the hypothesis that more extensive surgery prolongs survival. Instead higher post operative morbidity has argued in favour of more conventional techniques. However, a recent large German-Austrian randomized study (Siewert <i>et aI., Br J Surg</i>, 80, 1015, 1993) did demonstrate that a subgroup of gastric cancer patients did benefit from more extensive lymph node dissection. The data pros and cons and their potential consequences are discussed.