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🌱 來自: gastric cancer

Locoregional disease-of-gastric cancer

Gastrectomy is potentially curative, >50% relapse; perioperative chemo if ≥T2 or N+ Resection: Goal R0 (Complete resection, clear margins [≥4 cm]); ∼50% achieve R0 R1: Microscopic residual dz (+margins); R2: Gross (macroscopic) residual dz LN dissection: D2 (standard of care)-includes D1 & removal of celiac, gastrohepatic, & splenic LN (15-30 LN for adequate staging); lower locoregional recurrence (12% vs. 22%) & CA-related mortality (37% vs. 48%) compared to D1 (Lancet Oncol 2010;11:439) D1: Gastrectomy w/ removal of greater & lesser omenta & associated LN D0: Incomplete resection of greater & lesser curvature LN dMMR/MSI-H: Always evaluate for mismatch repair deficiency prior to initiating periop Rx