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World J Gastroenterol. Oct 14, 2014; 20(38): 13692-13704
Published online Oct 14, 2014. doi: 10.3748/wjg.v20.i38.13692
Improving the outcomes in gastric cancer surgery
Juul JW Tegels, Michiel FG De Maat, Karel WE Hulsewé, Anton GM Hoofwijk, Jan HMB Stoot
Juul JW Tegels, Michiel FG De Maat, Karel WE Hulsewé, Anton GM Hoofwijk, Jan HMB Stoot, Department of Surgery, Orbis Medical Center, 6130 MB Sittard, The Netherlands
Michiel FG De Maat, Department of Surgery, Maastricht University Medical Center, 6211 LK Maastricht, The Netherlands
Karel WE Hulsewé, Anton GM Hoofwijk, Jan HMB Stoot, Department of Surgery, Atrium Medical Center, 6461 AL Heerlen, The Netherlands
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
Received: December 28, 2013
Revised: February 8, 2014
Accepted: May 29, 2014
Published online: October 14, 2014
Processing time: 291 Days and 20.5 Hours
Abstract

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 five-year 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.

Keywords: Gastric cancer; Laparoscopic surgery; Risk assessment; Surgical outcome; Postoperative care

Core tip: In gastric cancer surgery comorbidities, nutritional status and geriatric frailty should be assessed to judge surgical risks in preoperative assessment. Improving postoperative recovery by laparoscopic surgery has improved outcomes for these patients. Enhanced recovery after surgery and fast-track programs should aim to further improve recovery after surgery. Advances have been made, however many areas for future research and improvement remain.