Linitis plastica surgery: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Linitis plastica}} | {{Linitis plastica}} | ||
{{CMG}}{{AE}} {{ | {{CMG}};{{AE}}{{HM}} | ||
==Oveview== | ==Oveview== | ||
Total [[gastrectomy]] is recommended for the management of local disease. Surgical resection is not recommended among patients with metastatic linitis plastica | Total [[gastrectomy]] is recommended for the management of local disease. However, it is important to note that patients with linitis plastica usually present at an advance stage when metastasis has already occurred, surgery at this point is often not curative but rather to improve the chances of survival. Surgical resection is not recommended among patients with metastatic linitis plastica, radiotherapy and chemotherapy are utilized instead. | ||
==Surgery== | ==Surgery== | ||
* | *The surgery of choice in linitis plastica is a total gastrectomy.<ref name="pmid25436387">{{cite journal| author=Kim JY, Ha TK, le Roux CW| title=Metabolic effects of gastrectomy with or without omentectomy in gastric cancer. | journal=Hepatogastroenterology | year= 2014 | volume= 61 | issue= 134 | pages= 1830-4 | pmid=25436387 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25436387 }}</ref><ref name="pmid27342689">{{cite journal| author=Japanese Gastric Cancer Association| title=Japanese gastric cancer treatment guidelines 2014 (ver. 4). | journal=Gastric Cancer | year= 2017 | volume= 20 | issue= 1 | pages= 1-19 | pmid=27342689 | doi=10.1007/s10120-016-0622-4 | pmc=5215069 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27342689 }}</ref> | ||
* | *A total gastrectomy is total resection of the stomach including the [[cardia]] and [[pylorus]] | ||
* | |||
==== Selection of the surgery ==== | |||
* The standard surgical procedure is total or distal [[gastrectomy]]. | |||
* '''Pancreaticosplenectomy''' | |||
**[[Pancreas|Pancreatic]] invasion by tumor requires total [[gastrectomy]] regardless of the [[tumor]] location. | |||
* '''Total gastrectomy with splenectomy''' | |||
**It should be considered for [[Tumor|tumors]] that are located along the greater curvature with [[metastasis]] to no. 4 [[Lymph node|lymph nodes]]. | |||
=== Lymph nodes resection === | |||
* One of the most controversial areas in the surgical management of gastric cancer is the optimal extent of [[lymph node]] dissection.<ref name="pmid11147594">{{cite journal| author=Noguchi Y, Yoshikawa T, Tsuburaya A, Motohashi H, Karpeh MS, Brennan MF| title=Is gastric carcinoma different between Japan and the United States? | journal=Cancer | year= 2000 | volume= 89 | issue= 11 | pages= 2237-46 | pmid=11147594 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11147594 }}</ref> | |||
* The draining [[Lymph node|lymph nodes]] for the [[stomach]] have been meticulously divided into 16 stations by Japanese surgeons; stations 1 to 6 are perigastric, and the remaining 10 are located adjacent to major vessels, behind the [[pancreas]], and along the [[aorta]].<ref name="pmid21573743">{{cite journal| author=Japanese Gastric Cancer Association| title=Japanese classification of gastric carcinoma: 3rd English edition. | journal=Gastric Cancer | year= 2011 | volume= 14 | issue= 2 | pages= 101-12 | pmid=21573743 | doi=10.1007/s10120-011-0041-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21573743 }}</ref> | |||
'''D1 lymphadenectomy''' | |||
* It refers to a dissection of only the perigastric [[Lymph node|lymph nodes]]. | |||
* A D1 [[lymphadenectomy]] is indicated for T1a [[Tumor|tumors]] that do not meet the criteria for EMR/ ESD and for T1bN0 tumors that are histologically of differentiated type and 1.5 cm or smaller in diameter. | |||
'''D2 lymphadenectomy''' | |||
* It is an extended [[lymph node]] dissection, includes removal of nodes along the [[hepatic]], [[Left gastric artery|left gastric]], [[Celiac artery|celiac]], and [[Spleen|splenic]] arteries, as well as those in the [[splenic hilum]]. | |||
* It is indicated for potentially curable T2-T4 tumors. | |||
* A D2 [[lymphadenectomy]] should be performed whenever nodal involvement is suspected. | |||
'''D3 dissection''' | |||
* It is a superextended lymphadenectomy. The surgery includes D2 lymphadenectomy plus the removal of '''nodes within the [[porta hepatis]] and periaortic regions.'''<ref name="pmid18669424">{{cite journal| author=Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A et al.| title=D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. | journal=N Engl J Med | year= 2008 | volume= 359 | issue= 5 | pages= 453-62 | pmid=18669424 | doi=10.1056/NEJMoa0707035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18669424 }}</ref> | |||
=== Local palliative preocedures=== | |||
* Therapeutic options to control [[symptoms]] of local [[disease]] progression, such as [[nausea]], [[pain]], [[bleeding]], and [[obstruction]], include [[palliative]] surgical [[resection]], [[surgical]] bypass ([[gastrojejunostomy]]), [[radiation therapy]] (RT), and [[endoscopic]] techniques. | |||
* '''Palliative resection''' | |||
**[[Palliative]] [[gastrectomy]] should be reserved for extreme, highly [[symptomatic]] cases where less invasive methods cannot be used.<ref name="pmid10791239">{{cite journal| author=Kikuchi S, Arai Y, Kobayashi N, Tsukamoto H, Shimao H, Sakakibara Y et al.| title=Is extended lymphadenectomy valuable in palliatively gastrectomized patients with gastric cancer and simultaneous peritoneal metastasis? | journal=Hepatogastroenterology | year= 2000 | volume= 47 | issue= 32 | pages= 563-6 | pmid=10791239 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10791239 }}</ref> | |||
**Two-year survival for [[chemotherapy]] alone versus [[gastrectomy]] plus [[chemotherapy]] was 32 versus 25 percent. | |||
**Patients undergoing [[gastrectomy]] had a significantly higher [[incidence]] of several serious adverse events related to [[chemotherapy]], including [[Leukopenia|leucopenia]], [[nausea]], [[anorexia]], and [[hyponatremia]]. | |||
=== Reconstruction after gastrectomy === | |||
'''Total gastrectomy''' | |||
* Roux-en-Y esophagojejunostomy<ref name="pmid26379405">{{cite journal| author=Xiao JW, Liu ZL, Ye PC, Luo YJ, Fu ZM, Zou Q et al.| title=Clinical comparison of antrum-preserving double tract reconstruction vs roux-en-Y reconstruction after gastrectomy for Siewert types II and III adenocarcinoma of the esophagogastric junction. | journal=World J Gastroenterol | year= 2015 | volume= 21 | issue= 34 | pages= 9999-10007 | pmid=26379405 | doi=10.3748/wjg.v21.i34.9999 | pmc=4566393 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26379405 }}</ref> | |||
* Jejunal interposition | |||
* Double tract method | |||
== Video shows gastrectomy steps == | |||
{{#ev:youtube|5rj7M4kZKp0}} | |||
==References== | ==References== | ||
Revision as of 18:24, 12 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Oveview
Total gastrectomy is recommended for the management of local disease. However, it is important to note that patients with linitis plastica usually present at an advance stage when metastasis has already occurred, surgery at this point is often not curative but rather to improve the chances of survival. Surgical resection is not recommended among patients with metastatic linitis plastica, radiotherapy and chemotherapy are utilized instead.
Surgery
- The surgery of choice in linitis plastica is a total gastrectomy.[1][2]
- A total gastrectomy is total resection of the stomach including the cardia and pylorus
Selection of the surgery
- The standard surgical procedure is total or distal gastrectomy.
- Pancreaticosplenectomy
- Pancreatic invasion by tumor requires total gastrectomy regardless of the tumor location.
- Total gastrectomy with splenectomy
- It should be considered for tumors that are located along the greater curvature with metastasis to no. 4 lymph nodes.
Lymph nodes resection
- One of the most controversial areas in the surgical management of gastric cancer is the optimal extent of lymph node dissection.[3]
- The draining lymph nodes for the stomach have been meticulously divided into 16 stations by Japanese surgeons; stations 1 to 6 are perigastric, and the remaining 10 are located adjacent to major vessels, behind the pancreas, and along the aorta.[4]
D1 lymphadenectomy
- It refers to a dissection of only the perigastric lymph nodes.
- A D1 lymphadenectomy is indicated for T1a tumors that do not meet the criteria for EMR/ ESD and for T1bN0 tumors that are histologically of differentiated type and 1.5 cm or smaller in diameter.
D2 lymphadenectomy
- It is an extended lymph node dissection, includes removal of nodes along the hepatic, left gastric, celiac, and splenic arteries, as well as those in the splenic hilum.
- It is indicated for potentially curable T2-T4 tumors.
- A D2 lymphadenectomy should be performed whenever nodal involvement is suspected.
D3 dissection
- It is a superextended lymphadenectomy. The surgery includes D2 lymphadenectomy plus the removal of nodes within the porta hepatis and periaortic regions.[5]
Local palliative preocedures
- Therapeutic options to control symptoms of local disease progression, such as nausea, pain, bleeding, and obstruction, include palliative surgical resection, surgical bypass (gastrojejunostomy), radiation therapy (RT), and endoscopic techniques.
- Palliative resection
- Palliative gastrectomy should be reserved for extreme, highly symptomatic cases where less invasive methods cannot be used.[6]
- Two-year survival for chemotherapy alone versus gastrectomy plus chemotherapy was 32 versus 25 percent.
- Patients undergoing gastrectomy had a significantly higher incidence of several serious adverse events related to chemotherapy, including leucopenia, nausea, anorexia, and hyponatremia.
Reconstruction after gastrectomy
Total gastrectomy
- Roux-en-Y esophagojejunostomy[7]
- Jejunal interposition
- Double tract method
Video shows gastrectomy steps
{{#ev:youtube|5rj7M4kZKp0}}
References
- ↑ Kim JY, Ha TK, le Roux CW (2014). "Metabolic effects of gastrectomy with or without omentectomy in gastric cancer". Hepatogastroenterology. 61 (134): 1830–4. PMID 25436387.
- ↑ Japanese Gastric Cancer Association (2017). "Japanese gastric cancer treatment guidelines 2014 (ver. 4)". Gastric Cancer. 20 (1): 1–19. doi:10.1007/s10120-016-0622-4. PMC 5215069. PMID 27342689.
- ↑ Noguchi Y, Yoshikawa T, Tsuburaya A, Motohashi H, Karpeh MS, Brennan MF (2000). "Is gastric carcinoma different between Japan and the United States?". Cancer. 89 (11): 2237–46. PMID 11147594.
- ↑ Japanese Gastric Cancer Association (2011). "Japanese classification of gastric carcinoma: 3rd English edition". Gastric Cancer. 14 (2): 101–12. doi:10.1007/s10120-011-0041-5. PMID 21573743.
- ↑ Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A; et al. (2008). "D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer". N Engl J Med. 359 (5): 453–62. doi:10.1056/NEJMoa0707035. PMID 18669424.
- ↑ Kikuchi S, Arai Y, Kobayashi N, Tsukamoto H, Shimao H, Sakakibara Y; et al. (2000). "Is extended lymphadenectomy valuable in palliatively gastrectomized patients with gastric cancer and simultaneous peritoneal metastasis?". Hepatogastroenterology. 47 (32): 563–6. PMID 10791239.
- ↑ Xiao JW, Liu ZL, Ye PC, Luo YJ, Fu ZM, Zou Q; et al. (2015). "Clinical comparison of antrum-preserving double tract reconstruction vs roux-en-Y reconstruction after gastrectomy for Siewert types II and III adenocarcinoma of the esophagogastric junction". World J Gastroenterol. 21 (34): 9999–10007. doi:10.3748/wjg.v21.i34.9999. PMC 4566393. PMID 26379405.