Surgery for Gastric Cancer

Contents
Part I: History of Gastric Cancer Surgery
	1: History of Gastric Cancer Surgery
		Progress of Supportive Background for Gastric Cancer Surgery
			Anesthesia
			Aseptic Method
			Antibacterial Agents
			Intravenous Infusion Therapy
			Suture Materials and Surgical Instruments
			Advancement in Pathological Knowledge
			Progress of Diagnostic Methods
		Challengers of Gastric Resection
		Powerful Drive for Curability
			Total Gastrectomy
			Combined Resection of the Neighboring Organs
			Lymph Node Dissection
			Surgery for Peritoneal Metastasis
		New Trends: From Standardized Surgery to Individual Surgery
			Function-Preserving Surgery
			Optimal Extent of Lymph Node Dissection
			Minimally Invasive Surgery
		National and International Study Groups for Gastric Cancer
		Last Comment
		References
Part II: Staging of Gastric Cancer
	2: Staging of Gastric Cancer: Current Revision and Future Proposal
		Revisions on the Current Edition TNM Classification for Gastric Cancer
			Explicit Staging in Esophagogastric Junction Carcinoma
			Proposal of Positive Cytology as Distant Metastasis
			Minimum Number of Examined Lymph Nodes
			Proposed Lymph Node Ratio to Be Included in the Staging System
			Prefix “y” for TNM Classification After Neoadjuvantly Treated Tumor
		Proposal of the Next Edition TNM Classification for Gastric Cancer
			Amendment Both Extent and Number of Dissected Lymph Nodes as the Prerequisites for Staging the Lymph Node Metastasis
			Occult Tumor Cells in Lymph Nodes as a Novel Subcategory of N Stage
			Extracapsular Lymph Node Involvement in Gastric Cancer
			Other Variables’ Assessment for Enhancement of the Efficiency of Stage of Gastric Cancer
		References
Part III: Diagnosis of Gastric Cancer
	3: Endoscopic Diagnosis: Esophagogastroduodenoscopy (EGD) and Endoscopic Ultrasound (EUS)
		EGD
			Early Gastric Cancer (EGC)
			Tips for Early Detection of Gastric Cancer
			Advanced Gastric Cancer (AGC)
		EUS
		References
	4: Radiologic Diagnosis (CT, MRI, & PET-CT)
		CT
			Introduction
			Tumor Staging
				T Staging
				N Staging
				M Staging
				Preoperative Evaluation of Perigastric Vascular Anatomy
			Differential Diagnosis
				Mucinous Adenocarcinoma
				Lymphoma
				Helicobacter Gastritis
		MR Imaging
		PET-CT
			Introduction
			Diagnosis and TNM Staging with FDG PET/CT
				Diagnosis
				Lymph Node Staging
				Metastasis
		References
Part IV: Treatment of Gastric Cancer
	5: Endoscopic Treatment for Early Gastric Cancer
		Introduction
		History of Endoscopic Resection
		Treatment Strategy for Endoscopic Resection
			Principle
			Indication Criteria
		Pathological Staging
		Clinical Management After Endoscopic Resection
		References
Part V: Open Surgery for Gastric Cancer
	6: Open Surgery for Gastric Cancer: Distal Subtotal Gastrectomy with D2 Lymph Node Dissection
		Introduction
			D2 Lymph Node Dissection
			Oncologic Principles for Gastric Cancer Surgery
			Omentectomy and Bursectomy
		Surgical Procedure for Distal Subtotal Gastrectomy with D2 Lymph Node Dissection
			Indication
			Contraindication
			Preoperative preparation
			Anesthesia
			Position of Patient During Surgery
			Incision, Exposure, and Preparation of Main Procedures
			Details of Procedure for D2 Lymph Node Dissection
				Total Omentectomy and Bursectomy
				Dissection of Lymph Node #6
				Dissection of Lymph Nodes #4d and #4sb
				Dissection of Lymph Node #5 and Duodenal Transection
				Suprapancreatic Lymph Node Dissection (#12a, #8a, #7, #11p, and #9)
				Dissection of Lymph Nodes #1 and #3
				Gastric Resection to Achieve a Tumor-Free Proximal Margin
			Checking the Status of Lymph Nodes According to Their Anatomical Location
		Discussion
		References
	7: Open Surgery for Gastric Cancer: Total Gastrectomy with D2 Lymph Node Dissection
		Introduction
			Beginning of TG
			Extent of Lymph Node Dissection of TG for Gastric Cancer
			Era of Combined Resection Moved to Organ Preservation for TG
		Surgical Procedure for Total Gastrectomy with D2 Lymph Node Dissection
			Dissection of Lymph Nodes #11d
			Dissection of Lymph Nodes #4sa, #10, and #2
		References
	8: Gastrectomy with D3 Lymph Node Dissection
		Indication
			Prophylactic Nodal Dissection
			Therapeutic Dissection
		Technique
		References
	9: Open Surgery for Gastric Cancer: Reconstruction
		Introduction
		Operative Technique
			Reconstruction After Distal Gastrectomy
				Gastroduodenostomy (Billroth I Reconstruction)
					Surgical Technique
				Gastrojejunostomy (Billroth II Reconstruction)
					Surgical Technique
				Roux-en-Y Gastrojejunostomy
					Surgical Technique
			Reconstruction After Total Gastrectomy
				Roux-en-Y Esophagojejunostomy
					Surgical Technique
		Summary
		References
Part VI: Laparoscopic Surgery for Gastric Cancer
	10: Laparoscopic Surgery for Gastric Cancer: Distal Subtotal Gastrectomy with D2 Lymph Node Dissection
		Introduction
		Setup
			List of Instruments
			Patients
			OR Setup
			Patient’s Position
			Trocar Arrangement (Fig. 10.3)
		D2 Lymph Node Dissection
			Outermost Layer-Oriented Medial Approach
			Details of D2 Dissection in Distal Gastrectomy
				#4d Dissection
				#4sb Dissection
				#6 Dissection
				Transection of the Duodenum
				Lesser Omentum, Top of #1
				Rolling Up the Stomach
				Probing the Outermost Layer of CHA and SPA
				#5 Dissection
				Medial Approach [1, 11]
				#12a Dissection
				#9(R) Dissection
				#7 Dissection
				#11p Dissection
				#9(L) Dissection
				#1 and 3 Dissection
				Transection of the Stomach
		Results
		Discussion
		Conclusions
		References
	11: Laparoscopic Surgery for Gastric Cancer, Total Gastrectomy with D2 Lymph Node Dissection
		Introduction
		Setup
			Indications for Laparoscopic Total Gastrectomy with D2 Lymph Node Dissection
			OR Setup
			Patient’s Position
			Port Placement
			Liver Retraction
			Details of D2 Dissection in Total Gastrectomy
				Omentectomy
				#4sb Dissection #4sa Dissection
				#11d and #10 Dissection
				#2 Dissection
				#4d and #6 Dissection and Duodenal Transection
				Suprapancreatic Dissection (#5, #12a, #8, #7, #9, #1, and #11p)
				Distal Esophagus Transection
				Reconstruction and Specimen Retrieval
				Splenectomy for #10 Dissection
		References
	12: Intracorporeal Reconstruction in Laparoscopic Gastrectomy
		Introduction
		Materials and Methods
			Patients
			Operative Technique
				Reconstruction in LDG
				Reconstruction in LTG
		Results
		Discussion
		Conclusions
		References
Part VII: Robotic Surgery for Gastric Cancer
	13: Distal Subtotal Gastrectomy with D2 Lymph Node Dissection
		Introduction
		Advantages of Robotic Gastrectomy and Clinical Assessment of Its Application
			Overview
			Specific Advantages in Robotic Gastrectomy with D2 Lymphadenectomy
			Clinical Assessment of Robotic Gastrectomy
		Indication
		Operative Procedures [7, 25, 26]
			Operating Room Setup
			Patient Positioning and Port Placement
			Docking
			Instrumentations
			Liver Retraction
			Left-Side Dissection and Greater Curvature Mobilization (Lymph Node #4sb and #4d Dissection)
			Right-Side Dissection and Infrapyloric Area Dissection (Lymph Node #6 and #14v Dissection)
			Supraduodenal Dissection and Duodenal Transection
			Suprapancreatic Area Dissection (Lymph Node #5, #7, #8a, #9, #11p, and #12a Dissection)
			Lesser Curvature Dissection (Lymph Node #1 and #3 Dissection)
			Gastric Resection, Anastomosis, and Specimen Retrieval
		Limitation and Future Perspectives
		Conclusion
		References
	14: Total Gastrectomy with D2 Lymph Node Dissection
		Introduction
		Indications for Robotic TG with D2 Lymph Node Dissection
		Robot Setup and Patient Positioning
		Surgical Technique
			Splenic Hilar Dissection
			Dissection of the Left Side Gastropancreatic Fold
			Dissection of the Right Side Gastropancreatic Fold
			Reconstruction
		Discussion
		References
	15: Reconstruction Methods After Robotic Distal or Total Gastrectomy
		Introduction
		Operative Setting and Preparation for Reconstructions
		Intracorporeal Billroth I Reconstruction after Robotic Distal Gastrectomy
			Surgical Techniques for Linear-Shaped Gastroduodenostomy
		Intracorporeal Roux-en-Y Esophagojejunostomy After Robotic Total Gastrectomy
			Surgical Techniques for the Modified Overlap Method Using Barbed Sutures (MOBS)
		Conclusions
		References
Part VIII: Function-Preserving Surgery
	16: Pylorous-Preserving Gastrectomy
		Introduction
		Indication
		Surgical Techniques (Figs. 16.1, 16.2, 16.3, and 16.4 and Video)
			Oncologic Safety
		Advantages and Pitfalls
		KLASS-04 Study: A Multicenter Prospective Randomized Controlled Trial
		References
	17: Surgery for Gastric Cancer: Proximal Gastrectomy
		Introduction
		Extent of Resection and Lymphadenectomy
		Reconstruction Methods and Complications
		Functional Benefits
		Oncologic Safety
		Conclusion
		References
	18: Vagus-Preserving Gastrectomy
		Introduction
		Surgical Anatomy
			Hepatic Branch
			Celiac Branch
			Hepatic Nerve Plexus
		Operational Procedure
		Short-Term Results
		Long-Term Results
		Conclusion
		References
Part IX: Sentinel Node Navigation Surgery
	19: Sentinel Node Navigation Surgery
		Introduction
		Laparoscopic SN Mapping Procedures for Gastric Cancer
		Results of SN Mapping in Gastric Cancer
		Clinical Application of Laparoscopic SN Navigation Surgery in Early Gastric Cancer
		Non-exposed Endoscopic Wall-Inversion Surgery Plus SN Mapping
		Conclusion
		References
Part X: Surgery for EG Junction Cancer
	20: Surgery for EG Junction Cancer
		Gastric Cancer or Esophageal Cancer or Else?
		Surgical Procedures
		Lymphadenectomy
		Our Surgical Procedure
		References
Part XI: Surgery After Neoadjuvant Chemotherapy
	21: Surgery After Neoadjuvant Chemotherapy
		Introduction
		Clinical Trials for Neoadjuvant Chemotherapy and Their Surgical Outcomes
		MAGIC
		ACCORD
		EORTC
		Implications of Surgical Outcomes After Neoadjuvant Chemotherapy
		Conclusions
		References
Part XII: Surgery for Remnant Gastric Cancer
	22: Surgery for Remnant Gastric Cancer: Open Surgery
		Introduction
		Clinicopathologic Characteristics of Remnant Gastric Cancer
		Lymph Node Metastases in Remnant Gastric Cancer
		Minimally Invasive Treatment for Remnant Gastric Cancer
			Endoscopic Treatment
			Laparoscopic and Robotic Surgery
			Open Surgery for Remnant Gastric Cancer
		Treatment Outcomes of Remnant Gastric Cancer
		Discussion
		References
	23: Laparoscopic Surgery
		Introduction
		Indications
		Preoperative Evaluation
		Operating Room Setup and Patient Position
		Trocar Placement
		Surgical Procedures
			Patients Who Previously Underwent Billroth I Reconstruction
			Patients Who Previously Underwent Billroth II Reconstruction
		Our Clinical Experience
		Discussion
			Short-Term Outcome
			Long-Term Outcome
		Conclusion
		References
Part XIII: Peritonectomy and HIPEC
	24: Prevention and Treatment of Peritoneal Metastases from Gastric Cancer
		Introduction
		Perioperative Intraperitoneal Chemotherapy as an Adjuvant Treatment
			Rationale of Perioperative Timing of Intraperitoneal Chemotherapy
		Perioperative Chemotherapy with D2 Gastrectomy
			Literature Regarding Perioperative Intraperitoneal Chemotherapy for Advanced T-Stage Primary Gastric Cancer
		Gastric Cancer with Peritoneal Metastases
			CRS and HIPEC as an Effective Strategy
			Role of Laparoscopy for Patient Selection
		Neoadjuvant Intraperitoneal and Systemic Chemotherapy (NIPS)
			Patients Treated
			Chemotherapy Regimen
		Surgery for Gastric Cancer with Peritoneal Metastases After Neoadjuvant Intraperitoneal and Systemic Chemotherapy (NIPS)
		Results After Neoadjuvant Intraperitoneal and Systemic Chemotherapy (NIPS)
			Adverse Events from Neoadjuvant Intraperitoneal and Systemic Chemotherapy (NIPS) and Cytoreductive Surgery
			Clinical Data Supporting Complete Cytoreduction as the Goal in Management of Gastric Cancer Patients with Peritoneal Seeding
			Palliative Benefits to All Patients with Cancerous Ascites
			Chemotherapy Agents Selected for Neoadjuvant Intraperitoneal and Systemic Chemotherapy (NIPS)
		References
Part XIV: Palliative Surgery (Including Resection, Bypass and Stent)
	25: Palliative Therapy for Gastric Cancer
		Local Palliative Care
		Palliative Gastrectomy
		Gastrojejunal Anastomosis
		Endoscopic Stent Placement
		Palliative Radiotherapy
		Endoscopic Laser Therapy
		Conclusions and Recommendations
		References
Part XV: Postoperative Management and Follow-Up
	26: Management of Early Postoperative Complication
		Incidence
			Risk Factors Related with Early Complication Following Gastrectomy
			Early Postoperative Complications
				Bleeding (Intra-abdominal, Intraluminal)
				Anastomosis Leakage
				Obstruction
				Pancreatic Abscess and Fistula
				Delayed Gastric Emptying
				Miscellaneous
		Conclusion
		References
	27: Management of Late Postoperative Complications
		Introduction
		Functional Disorders
			Early Dumping Syndrome
			Late Dumping Syndrome
			Delayed Gastric Emptying
			Roux Stasis Syndrome
			Diarrhea
			Constipation
			Digestion and Absorption Disorders
			Lactose Intolerance
			Fatty Stool
			Anemia
			Metabolic Bone Disease
		Organic Disorders
			Reflux Esophagitis
			Anastomotic Ulcers
			Anastomotic Stenosis
			Cholecystolithiasis and Cholecystitis
			Afferent Loop Syndrome
			Ileus
			Internal Hernia
		Evaluation of Postoperative QOL
		References
	28: Follow-Up After Gastric Cancer Treatment
		Introduction
		Recurrence Patterns of Gastric Cancer
			Timing of Recurrence
			Location of Recurrence
			Predictive Scoring for Recurrence
		Surveillance Modalities
			Imaging
				Computed Tomography
				Magnetic Resonance Imaging and Endoscopic Ultrasound
				Positron Emission Tomography/Computed Tomography
			Laparoscopy
			Endoscopy
				Endoscopy After Partial Gastrectomy
				Endoscopy After Total Gastrectomy
				Endoscopy After Endoscopic Resection
			Tumour Markers
		Follow-Up and Survival
		Other Primary Cancers
		Clinical Guidelines and Recommendations
		The Future
			Nurse-Led Follow-Up
			Novel Prognostic and Therapeutic Modalities
		Conclusion
		References
Part XVI: Neoadjuvant and Adjuvant Treatments for Gastric Cancer
	29: Neoadjuvant Treatment for Gastric Cancer
		Rationale of Neoadjuvant Treatment
		Neoadjuvant Chemotherapy
		Perioperative Chemotherapy
		Neoadjuvant Chemoradiotherapy
		Conclusions
		References
	30: Adjuvant Treatment for Gastric Cancer
		Meta-analysis of Adjuvant Chemotherapy in Gastric Cancer
		ACTS-GC Trial
		CLASSIC Trial
		SAMIT Trial
		Concluding Remarks
		References
	31: Radiation Therapy for Gastric Cancer
		Radiation and GI Tract
		Preoperative Neoadjuvant Radiation Therapy
		Postoperative Adjuvant Radiation Therapy
			Patterns of Failure After Surgical Resection
			Earlier Prospective Randomized Trials Including INT 0116
			Postoperative Chemoradiotherapy in Patients with D2 Gastrectomy
			Radiation Targets in D2-Dissected Gastric Cancer
			Treatment-Related Complication in Clinical Trials
		Palliative Radiation Therapy
		References
	32: Novel Agents and the Future Perspectives
		Introduction
		Epidermal Growth Factor Receptor (EGFR)/Human Epidermal Receptor (HER) Inhibitors
			Anti-EGFR Monoclonal Antibody (mAbs)
				Panitumumab
				Cetuximab
			Anti-HER2 mAbs
				Trastuzumab
				Trastuzumab Emtansine (T-DM1)
				Pertuzumab
			HER2 Tyrosine Kinase Inhibitors (TKIs)
				Lapatinib
		Angiogenesis Inhibitors
			Anti-vascular Endothelial Growth Factor (VEGF) mAbs
				Bevacizumab
				Ramucirumab
			VEGFR TKI
				Apatinib
		Other Targeted Agents
			Mammalian Target of Rapamycin (mTOR) Inhibitors
			Mesenchymal-Epithelial Transition Factor (MET) Inhibitors
				Rilotumumab
				Onartuzumab
			Poly ADP-Ribose Polymerase (PARP) Inhibitor
				Olaparib
		Immunotherapy
			PD-1 Inhibitor
				Nivolumab
				Pembrolizumab
			PD-L1 Inhibitor
		Conclusions
		References