Abstract
Gastric cancer is the fourth most common cancer and accounts for approximately 600,000 new cases each year worldwide. Seventy-five percent of gastric cancer occurs in developing countries in the regions of Eastern Europe and East Asia. The incidence of gastric cancer in the United States has been decreasing over the last 60 years, and in 2007, there were 21,260 new cases diagnosed. Almost two-thirds of these patients will die of their disease. Ninety-five percent of gastric carcinomas are adenocarcinomas. The remaining 5% are lymphoma, carcinoids, and gastrointestinal stromal tumors (GIST). Factors associated with an increased risk of gastric adenocarcinoma include diets high in salt and smoked foods, male gender, black race, and low socioeconomic class. Helicobacter pylori, a gram negative bacteria, is now known to play a central role in the pathogenesis of gastric cancer and is considered to be a carcinogen by the International Agency for Research on Cancer at the World Health Organization. Chronic long-term infection of the gastric mucosa with h pylori seems to be a major promoter of gastric carcinoma. In developing countries, 80–90% of children are infected with h pylori. Currently in the United States, the problems of h pylori infections have been steadily declining, probably because of smaller family size, better hygiene, and increased use of antibiotics during childhood. The decline in h pylori has probably contributed to the downward trend of gastric adenocarcinoma. Along with a decrease in gastric cancer, there has also been a steady decrease in mortality from gastric carcinoma in the United States.
Unfortunately, gastric adenocarcinoma usually presents with very nonspecific symptoms of weight loss, nausea, fatigue, and as the disease progresses, anorexia and vomiting. At the time of diagnosis in the United States, most patients either have locally advanced or metastatic disease. The distribution of disease or presentation is 24% with localized disease, 32% with node positive disease, and 32% with metastatic disease. Endoscopy with biopsy, CT, and endoscopic ultrasound, all aid in the diagnosis and staging of gastric carcinoma. Combined CT/PET is also extremely helpful in ruling out patients with metastatic disease. The overall accuracy of PET/CT is superior to either modality alone. Because of the limitations of CT and PET in the evaluation of peritoneal disease, diagnostic laparoscopy should be done before an open procedure in asymptomatic patients to avoid an unnecessary laparotomy. Several prospective studies have shown that laparoscopy will detect metastatic disease in 24–32% of patients thought to be resectable by standard imaging criteria. Multivari-ate analysis revealed that patients with diffuse gastric disease and lymphadenopathy, defined as nodes greater than 1 cm, were significant, are independent predictors for M1 disease. If a palliative resection and/or bypass are/is already planned, then lap-aroscopic staging is not necessary. In addition, laparoscopy can be a useful staging tool before neoadjuvant therapy is initiated.
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Suggested Readings
Ajani JA, Ota DM, Jessup JM, et al Resectable gastric carcinoma. Cancer 1991;68:1501–06
Beahrs O, Henson D, Hutter R, et al (editors). Handbook for staging of cancer. Philadelphia: JB Lippincott; 1993. p. 80–87
Boddie AW, McBride CM, Balch CM. Gastric cancer. Am J Surg. 1989;157:595–606
Bozzetti F, Bonfanti G, Bufalino R, et al Adequacy of margins of resection in gastrectomy for cancer. Ann Surg. 1982;196:685–90
Brady MS, Rogatko A, Dent L, et al Effect of splenectomy on morbidity and survival following curative gastrectomy for carcinoma. Arch Surg. 1991;126:359–64
Cady B. Subtotal gastric resection. In: Cady B, Daly J, editors. Atlas of surgical oncology. St Louis: Mosby;1993. p. 221–39
De Vita F, Giuliani F, Galizia G, Belli C, Aurilio G, Santabarbara G, Ciardiello F, Catalano G, Orditura M. Neo-adjuvant and adjuvant chemotherapy of gastric cancer. Ann Oncol. 2007;18(Suppl 6):vi120–23
Dougherty MJ, Compton C, Talbert M, et al Sarcomas of the gastrointestinal tract. Ann Surg. 1991;214:569– 74
Gold JS, DeMatteo RP. Combined surgical and molecular therapy. Ann Surg. 2006;244:176–84
Grobler NG. The stomach. In: Grobler NG, editor. Textbook of clinical anatomy. New York: Elsevier/North Holland Press; 1977. p. 267–83
Gutierrez JC, Pita De Oliveira LO, Perez EA, Rocha-Lima C, Livingstone AS, Koniaris LG. Optimizing diagnosis, staging, and management of gastrointestinal stromal tumors. J Am Coll Surg. 2007;205:479–91
Jensen EH, Tuttle TM. Preoperative Staging and Postoperative Surveillance for Gastric Cancer. Surg Oncol Clin N Am. 2007;16:329–42
Jesseph J. Gastrostomy. In: Nyhus L, Baker R, editors. Masters of surgery. Boston: Little Brown; 1992. p. 633–38
Jewkes A, Taylor E, Fielding J, et al Radical total gastrectomy for carcinoma. In: Nyhus L, Baker R, editors. Masters of surgery. Boston: Little Brown; 1992. p. 721–30
Kriplani AK, Kapur ML. Laparoscopy for pre-operative staging and assessment of operability in gastric carcinoma. Gastrointest Endosc. 1991;37:441–3
Lawrence M, Shiu MH. Early gastric cancer. Ann Surg. 1991;213:327–34
Lightdale CJ. Endoscopic ultrasound in the diagnosis, staging and follow-up of esophageal and gastric cancer. Endoscopy 1992;24:297–303
Morgan BK, Compton C, Talbert M, et al Benign smooth muscle tumors of the gastrointestinal tract. Ann Surg. 1990;211:63–6
Noguchi Y, Imada T, Matsumoto A, et al Radical surgery for gastric cancer: a review of the Japanese experience. Cancer 1989;64:2053–62
Pacelli F, Doglietto GB, Bellantone R, et al Extensive versus limited lymph node dissection for gastric cancer: a comparative study of 320 patients. Br J Surg. 1993;80:1153–6
Raut CP, Morgan JA, Ashley SW. Current issues in gastrointestinal stromal, tumors: incidence, molecular biology, and contemporary treatment of localized and advanced disease. Curr Opin Gastroenterol. 2007;23:149–56
Romanes GJ. The stomach. In: Romanes GJ, editor. Cunningham's textbook of anatomy. Oxford, England: Oxford University Press; 1981. p. 445–54
Smith JW, Shiu MH, Kelsey L, et al Morbidity of radical lymphadenectomy in the curative resection of gastric carcinoma. Arch Surg. 1991;126:1469–73
Snell R. The abdomen: part II. In: Snell R, editor. Clinical anatomy for medical students. Boston: Little Brown; 1973. p. 175–91
Thirlby RC. Gastrointestinal lymphoma: a surgical perspective. Oncology 1993;7:29–34
Suggested Readings
Bîhm B, Milsom JW, Kitago K, et al Use of laparoscopic techniques in oncologic right colectomy in a canine model. Ann Surg Oncol. 1995;2:6–13
Brown JP, Albala DM, Jahoda A. Laparoscopic surgery for adrenal lesions. Semin Surg Oncol. 1996;12:96–9
Clemente CD. The abdomen. In: Clemente CD, editor. Anatomy: a regional atlas of the human body. Baltimore: Urban and Schwarzenberg; 1987. p. 231–342
Cuesta MA, Meijer S, Borgstein PJ, et al Laparoscopic ultrasonography for hepatobiliary and pancreatic malignancy. Br J Surg. 1993;80:1571–74
Ellis H. Abdominal wall: incisions and closures. In: Schwartz SI, Ellis H, editors. Maingot 's abdominal operations. 8th ed. Norwalk, Conn.: Appleton-Century-Crofts; 1985. p. 247–63
Fernandez-Del Castillo C, Rattner DW, Warshaw AL. Further experience with laparoscopy and peritoneal cytology in the staging of pancreatic cancer. Br J Surg. 1995;82:1127–29
Fuhrman GM, Ota DM. Laparoscopic intestinal stomas. Dis Colon Rectum. 1994;37:444–49
Greene FL. Laparoscopic staging of malignancies. In: Arregui ME, Fitzgibbons RJ, Katkhouda N, McKernan JB, Reich H, editors. Principles of laparoscopic surgery. New York: Springer; 1995. p. 318–23
Hall-Craggs ECB (editor). The abdomen. In: Anatomy as a basis for clinical medicine. London: Williams & Wilkins Waverly Europe; 1995. p. 220–81
MacFadyen BV, Ricardo AE, Vecchio R. Ileostomy and colostomy. In: MacFadyen BV, Ponsky SL, editors. Operative laparoscopy and thoracoscopy. Philadelphia: Lippincott-Raven; 1996. p. 711–27
Reilly WT, Nelson H, Schroeder G, et al Wound recurrence following conventional treatment of colorectal cancer. Dis Colon Rectum. 1996;39:200–07
Schirmer BD. Laparoscopic colon resection. Surg Clin North Am. 1996;76:571–83
Shackelford RT, Zuidema GD (editors). Abdominal incisions. In: Surgery of the alimentary tract. Philadelphia: WB Saunders; 1981. p. 467–524
Snell R. The abdomen: part I. In: Snell R, editor. Clinical anatomy for medical students. Boston: Little Brown; 1973. p. 145–65
Unger SW, Edelman DS. Gastric and small bowel access for enteral feeding. In: MacFadyen BV, Ponsky SL, editors. Operative laparoscopy and thoracoscopy. Philadelphia: Lippincott-Raven; 1996. p. 619–28
Woodburne RT, Burkel WE. The abdomen. In: Woodburne RT, editor. Essentials of human anatomy. New York: Oxford University Press; 1994. p. 417–512
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Staley, C.A., Richardson, W.S. (2010). Stomach and Abdominal Wall. In: Wood, W.C., Staley, C.A., Skandalakis, J.E. (eds) Anatomic Basis of Tumor Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-74177-0_6
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DOI: https://doi.org/10.1007/978-3-540-74177-0_6
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