Surgical Oncology Techniques for Advanced Gastric Cancer
Summary
Advanced gastric cancer remains a leading cause of cancer mortality worldwide. Curative surgery typically entails total or subtotal gastrectomy combined with extended lymph node dissection to secure complete tumour clearance. The evolution from “open” to minimally invasive approaches has prioritised both oncological radicality and postoperative quality of life. Standardised D2 lymphadenectomy, encompassing perigastric and extraperigastric stations, is now the benchmark in high-incidence regions, while spleen- and pancreas-preserving techniques aim to reduce morbidity without compromising survival. Precise anatomical manoeuvres along pre- and retro-pancreatic planes facilitate access to the splenic hilar (no. 10) nodal basin, a critical site for advanced proximal tumours. Robotic platforms and refined laparoscopic skills further enhance dissection accuracy, supporting tailored resections that balance functional preservation with thorough oncological clearance.
Research from Nature Portfolio
Recent large-scale analyses have reinforced the prognostic benefit of dissecting splenic hilar lymph nodes during total gastrectomy for advanced proximal gastric cancer, particularly in Borrmann type 4 lesions. Weighted cohort studies employing inverse probability of treatment weighting demonstrated a significant increase in 5-year survival for patients undergoing splenic hilar (no. 10) lymphadenectomy compared with those without, after adjustment for tumour stage and other risk factors. Multivariate modelling confirmed the independent favourable impact of this extended dissection on long-term outcomes, supporting its integration into radical resection protocols for selected high-risk subtypes.
Surgical Oncology Techniques for Advanced Gastric Cancer publication trend
The graph below shows the total number of articles in surgical oncology techniques for advanced gastric cancer across all publications each year (not limited to Nature Index journals).
Technical terms
Total gastrectomy: Surgical removal of the entire stomach to achieve complete tumour resection in advanced disease.
D2 lymphadenectomy: Extended regional lymph node dissection including both perigastric and extraperigastric stations for improved staging and survival.
Splenic hilar lymph nodes (no. 10): Lymphatic tissue located at the splenic hilum, critical for clearance of proximal gastric tumours.
Borrmann type 4 tumour: Diffuse infiltrative gastric carcinoma with extensive local spread and poor differentiation.
Inverse probability of treatment weighting: A statistical method that balances baseline covariates to estimate causal effects in observational studies.
Retro-pancreatic approach: Surgical corridor posterior to the pancreas, utilised to access splenic hilar nodes while preserving pancreatic function.
References
- Splenic hilar lymph node dissection enhances survival in Bormann type 4 gastric cancer. Scientific Reports (2023).
- Laparoscopic spleen-preserving hilar lymph node dissection through pre-pancreatic and retro-pancreatic approach in patients with gastric cancer. Cancer Cell International (2016).
- A 346 Case Analysis for Laparoscopic Spleen-Preserving No.10 Lymph Node Dissection for Proximal Gastric Cancer: A Single Center Study. PLOS ONE (2014).
- Efficacy of prophylactic splenectomy for proximal advanced gastric cancer invading greater curvature. World Journal of Surgical Oncology (2017).
- Surgical treatment of gastric cancer: Current status and future directions. Chinese Journal of Cancer Research (2021).
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