Gastric Adenocarcinoma: Treatment Complete surgical removal of the tumor with resection of adjacent lymph nodes offers the only chance for cure. However, this is possible in less than a third of patients. A subtotal gastrectomy is the treatment of choice for patients with distal carcinomas, while total or near-total gastrectomies are required for more proximal tumors. The inclusion of extended lymph node dissection in these procedures appears to confer an added risk for complications without enhancing survival. The prognosis following complete surgical resection depends on the degree of tumor penetration into the stomach wall and is adversely influenced by. | Chapter 087. Gastrointestinal Tract Cancer Part 5 Gastric Adenocarcinoma Treatment Complete surgical removal of the tumor with resection of adjacent lymph nodes offers the only chance for cure. However this is possible in less than a third of patients. A subtotal gastrectomy is the treatment of choice for patients with distal carcinomas while total or near-total gastrectomies are required for more proximal tumors. The inclusion of extended lymph node dissection in these procedures appears to confer an added risk for complications without enhancing survival. The prognosis following complete surgical resection depends on the degree of tumor penetration into the stomach wall and is adversely influenced by regional lymph node involvement vascular invasion and abnormal DNA content . aneuploidy characteristics found in the vast majority of American patients. As a result the probability of survival after 5 years for the 25-30 of patients able to undergo complete resection is 20 for distal tumors and 10 for proximal tumors with recurrences continuing for at least 8 years after surgery. In the absence of ascites or extensive hepatic or peritoneal metastases even patients whose disease is believed to be incurable by surgery should be offered resection of the primary lesion. Reduction of tumor bulk is the best form of palliation and may enhance the probability of benefit from subsequent therapy. Gastric adenocarcinoma is a relatively radioresistant tumor and adequate control of the primary tumor requires doses of external beam irradiation that exceed the tolerance of surrounding structures such as bowel mucosa and spinal cord. As a result the major role of radiation therapy in patients has been palliation of pain. Radiation therapy alone after a complete resection does not prolong survival. In the setting of surgically unresectable disease limited to the epigastrium patients treated with 3500-4000 cGy did not live longer than similar patients not receiving radiotherapy .
