Surgery for Stomach Cancer: Removal of the Stomach and Lymph Nodes, but not Pancreas, Produces High Survival RatesSurgery for Stomach Cancer: Removal of the Stomach and Lymph Nodes, but not Pancreas, Produces High Survival Rates

The removal of the stomach and lymph nodes, but not the pancreas, has produced high survival rates in persons with stomach cancer, say researchers from Italy. These findings are important in the midst of some controversy about how extensive surgery for stomach cancer ought to be. Frequently, treatment involves the surgical removal of the entire stomach (called a

total gastrectomy). To control the cancer and to help prevent recurrence (or return) of the cancer, area lymph nodes and nearby organs, such as the spleen and pancreas, may also be removed. This extensive surgery, however, is associated with more complications than is a less extensive surgery. Researchers continue to develop new surgical approaches in an effort to achieve the most effective treatment strategy.

Researchers in Italy treated 228 persons with stage I to IV stomach cancer. All persons underwent a surgical procedure that spared the pancreas, but removed the stomach and area lymph nodes. One third of patients had mild to major surgical complications, with 4% dying from these complications. Five-year survival rates for all persons were: 97% for those with stage IA disease; 76% for those with stage IB disease; 63% for stage II disease; 36% for stage IIIA disease; and 27% for those with stage IIIB disease. For patients who had stage IV cancer, with spreading to the lymph nodes only, the 5-year survival rate was 20%.

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These findings indicate that surgery that spares the pancreas, but involves extensive removal of the lymph nodes and stomach, can produce high cure rates for persons with cancer of the stomach. Persons who have cancer of the stomach may wish to talk with their doctor about the risks and benefits of the different surgical approaches, or of participating in a clinical trial in which new chemotherapies and other treatments are being studied. Sources of information on ongoing clinical trials that can be discussed with a doctor include a comprehensive, easy-to-use service provided by the National Cancer Institute (cancer.gov) and the Clinical Trials section and service offered by Cancer Consultants.com (www.411cancer.com). (Archives of Surgery, Vol 135, No 1, 2000)

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