Prognostic Factors and Surgical Approaches in Gastric Cancer
Summary
Gastric cancer remains a leading cause of cancer mortality worldwide, with outcomes determined by a complex interplay of tumour biology, host factors and the extent of surgical intervention. Established prognostic indicators include TNM stage, depth of invasion, nodal status and the presence of lymphovascular or perineural invasion, each reflecting the propensity for dissemination and recurrence. Molecular subtypes—such as those defined by histological classifications and emerging genomic signatures—offer further stratification, guiding tailored systemic therapies. Radiological biomarkers, including computed-tomography-derived features of extramural venous invasion, are gaining traction as non-invasive predictors of response to immunotherapy and long-term survival. Nutritional status and patient performance also influence outcome by affecting postoperative recovery and tolerance of adjuvant treatments.
Surgical management has evolved from radical open gastrectomy to a spectrum of interventions matched to disease stage. Early lesions confined to the mucosa can be treated with endoscopic resection techniques, while locally advanced tumours demand gastrectomy with systematic lymphadenectomy, typically following a D2 template. The choice between total, proximal or subtotal gastrectomy hinges on tumour location and aims to preserve function without compromising oncological clearance. Attention to resection margins—3 cm for expansive and 5 cm for infiltrative growth patterns—ensures adequate local control. Reconstruction following gastrectomy varies, with Roux-en-Y being most common, although pouch and other variants may improve quality of life. Minimally invasive approaches, including laparoscopic and robotic gastrectomy, have demonstrated equivalent oncological outcomes with reduced postoperative morbidity. In selected cases of oligometastatic disease, synchronous resection of primary tumour and metastases after systemic therapy is under investigation to extend survival.
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Prognostic Factors and Surgical Approaches in Gastric Cancer publication trend
The graph below shows the total number of articles in prognostic factors and surgical approaches in gastric cancer across all publications each year (not limited to Nature Index journals).
Technical terms
Perineural invasion (PNI): Tumour cell infiltration along nerve sheaths, linked to immune modulation and poorer prognosis.
Lymphovascular invasion (LVI): Presence of cancer cells in lymphatic or blood vessels, indicating higher metastatic risk.
D2 lymphadenectomy: Systematic removal of perigastric and second-tier regional lymph nodes during gastrectomy.
Endoscopic submucosal dissection (ESD): Minimally invasive removal of early gastric neoplasms confined to mucosa or superficial submucosa.
Roux-en-Y reconstruction: Technique to restore gastrointestinal continuity after gastrectomy, reducing bile reflux and improving nutrition.
References
- Predicting response to immunotherapy in gastric cancer via assessing perineural invasion-mediated inflammation in tumor microenvironment. Journal of Experimental & Clinical Cancer Research (2023).
- Incidence, Stage, Treatment, and Survival of Noncardia Gastric Cancer. JAMA Network Open (2023).
- Computed tomography-detected extramural venous invasion-related gene signature: a potential negative biomarker of immune checkpoint inhibitor treatment in patients with gastric cancer. Journal of Translational Medicine (2023).
- Surgery Matters: Progress in Surgical Management of Gastric Cancer. Current Treatment Options in Oncology (2023).
- Distinct molecular subtypes of gastric cancer: from Laurén to molecular pathology. Oncotarget (2018).
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