Linitis plastica surgery
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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 advanced stage when metastasis has already occurred, surgery at this point is often not curative but rather improves 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 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 4 or more 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
- 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
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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.