Operative Tactics in Gastric Cancer — Problems of Gastric Replacement

At the moment the majority of the participants have the opinion that surgery according to the stage of the tumor is the adequate therapy for gastric cancer. Particularly Professor Longmire, who advocated total gastrectomy in earlier years, favors restricted surgery today. In his experience, the results of total gastrectomy were not better, but were even worse than the results of subtotal gastrectomy. Anyway, one has to take into account that the results of total gastrectomy are much better today than in previous years. This is particularly true for the mortality rate, but also for postoperative morbidity. Thus, the panel members agreed that the reduction of the mortality rate and the better technique of gastric replacement allow at least wider indication for total gastrectomy. The difficulty in doing restricted surgery is the uncertainty of the intraoperative staging; this is even true when frozen sections of the gastric resection line and of the lymph nodes are performed. In conclusion, the question whether to perform a total gastrectomy “de principe” is still open to discussion and has to be evaluated in further studies.