AMC suggests new excision guideline for gastric cancer

Lee Han-soo  Published 2020.06.29  16:20  Updated 2020.06.29 17:11


A research team at Asan Medical Center (AMC) said Monday that in conducting gastric cancer surgery, doctors could excise just one centimeter above the stomach instead of the current two to five centimeters.

Professor Kim Bum-soo of Asan Medical Center says excising right above the stomach during gastric cancer operation can be safe and improve the quality of patients’ post-operation life. (AMC)

“The more portion of the stomach we preserve, the better the quality of life for patients after the surgery,” it said. “We have confirmed that excising above one centimeter above the stomach has no difference in safety and recurrence rate.”

When gastric cancer develops, cancer cells can spread along the lymph nodes and blood vessels. Therefore, hospitals have to cut out the cancer-affected areas and part of the duodenum where the small intestine begins.

The current international standard gastric cancer surgery guidelines suggest that for advanced gastric cancer, physicians should excise five centimeters above the cancer-affected area as there could be invisible cancer cells that may have spread around the tumor. While the distance differs in the actual clinical setting, depending on the doctor's experience and the patient's condition, surgeons usually excise two to three centimeters above cancer to minimize the likelihood of recurrence.

However, the research team, led by Professor Kim Bum-soo at the hospital, has confirmed that it is safe if doctors remove only one centimeter above the cancer-infected area. Professor Kim Ah-mi at Korea University Ansan Hospital also participated in the study.

The researchers concluded so after analyzing the results of treatment for 1,500 patients with advanced gastric cancer up to 11 years after surgery.

During the research, the team divided the patients into four groups depending on the excision range above cancer affected area – excised one centimeter or less, one to three centimeters, three to five centimeters and five centimeters or more.

Each group's local recurrence rate during the entire analysis period was 5.9 percent, 6.5 percent, 8.4 percent, and 6.2 percent. Patients who excised less than one centimeter had the lowest local recurrence rate.

The local recurrence rate is the rate at which cancer has reoccurred near the initial cancer location.

The team also confirmed that gastric cancer's overall recurrence rate during the same period was 23.5 percent, 30.6 percent, 24 percent, and 24.7 percent for each group.

"Although the recurrence rate was the lowest in the group that excised one centimeter or less from cancer affected area, statistically adjusted results showed that the recurrence rate was almost the same in the four groups," Professor Kim said. "For this study to be reflected in the standard guideline for gastric cancer surgery, more related studies must be conducted."

However, the team expects that the study will serve as a basis for improving the quality of life for patients undergoing gastric cancer surgery, he added.

World Journal of Gastroenterology has published the result of the study.

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