Value of the Gastrectomy “de Principe”

Abstract

For gastric cancer, the only method of treatment at present available is surgery; the results so obtained, however, are far from satisfactory (Table 1). The reason for this lies not so much in the type of operation performed as in the stage of tumor development of most gastric cancers at the time of diagnosis and treatment, most being so advanced, that they are no longer curable surgically. Nevertheless, it is possible to cure this type of cancer with surgery as shown by the excellent results with early gastric cancer as well as a certain measure of success even with advanced gastric cancer. For this very reason, the question must be raised time and time again — particularly taking into account new developments or information from the diagnostic or pathomorphological fields — if there has been a recurrence of the carcinoma at the primary site of operation, that is, a locally recurrent tumor: was the operation sufficiently extensive? These tumors show a high morbidity as well as a high mortality rate. Perhaps most significant for the subsequent question up for discussion, the site of origin in up to 60% of cases was the gastric wall, in 30%, the perigastric lymph node tissue, and in approximately 10%, the duodenum (Table 2). The appearance of these locally recurrent tumors does, of course, in no way mean that more radical surgery could decisively reduce their frequency. It is, however, a reason and an obligation to test this possibility.