Saudi Oncology Society clinical management guideline series

King Fahad Specialist Hospital, Dammam, and the Department of Oncology
Al-ShehriCopyright Al-Shehri11211. 2014
MDPhDbazarbashi@gmail.comMBBSPhDMBChB, FRCPCMBChB, FRCRMDMBBCh, FRCP (UK)MBBSMDMBBS, ABSMDMBBSKing Fahad Specialist Hospital, Dammam, and the Department of Oncology
Princess Nora Oncology Center, King Abdulaziz Medical City
Jeddah, Kingdom of Saudi Arabia; RiyadhAl-Shehri335411442393511211. 2014Received 15th July 2014. Accepted 19th October 2014.Address correspondence and reprint request to: Dr. Shouki N. OPEN ACCESS
1.1 Type I -the center of the cancer or more than two-thirds of identifiable tumor mass is located >1 cm proximal to the anatomical gastro-esophageal junction 1.2 Type II -the center of the cancer or the tumor mass is located in an area extending one cm proximal to the gastro-esophageal junction to 2 cm distal to it 1.3 Type III -the center of the tumor or more than two-thirds of identifiable tumor mass is located >2 cm below the gastro-esophageal junction 1.4 Barrett's esophagus is identified as an esophagus in which the normal squamous lower esophageal epithelium has been replaced by intestinal type mucosa, which is visible macroscopically.
Type I will be treated as esophageal cancer and types II and III will be treated as gastric cancer. Ancillary studies: HER-2 immunoperoxidase studies (in accredited labs or with external quality control) and HER-2 florescent in-situ hybridization (FISH) -for patients with immuno score 2+ (in accredited labs or with external quality control) 1.6 Computed tomography (CT) scan of the chest, abdomen, and pelvis to assess the local, nodal, and distant spread. Limitations include low sensitivity to detect peritoneal metastasis <5 mm and underestimation of depth of wall invasion 6-9 (EL-2) 1.7 Barium studies (optional to define extent of surgery) [bib_ref] Double-contrast barium meal and upper gastrointestinal endoscopy. A comparative study, Dooley [/bib_ref] 1.8 Endoscopic ultrasonography (optional) [bib_ref] Diagnostic ability of high-frequency ultrasound probe sonography in staging early gastric cancer,..., Yoshida [/bib_ref] [bib_ref] Subtotal versus total gastrectomy for gastric cancer: five-year survival rates in a..., Bozzetti [/bib_ref] [bib_ref] Total versus subtotal gastrectomy for adenocarcinoma of the gastric antrum. A French..., Gouzi [/bib_ref] [bib_ref] An evidence-based medicine review of lymphadenectomy extent for gastric cancer, Yang [/bib_ref] [bib_ref] Quality of life after curative gastrectomy for gastric cancer in a randomised..., Wu [/bib_ref] [bib_ref] Long-term follow-up of patients with jejunal pouch reconstruction after total gastrectomy. A..., Iivonen [/bib_ref] [bib_ref] Quality of life in the long-term survivors after total gastrectomy for gastric..., Tyrvainen [/bib_ref] Total gastrectomy was carried out for proximal and mid body gastric tumors with a Roux-en-Y reconstruction to avoid alkaline reflux esophagitis. Distal subtotal gastrectomy for distal gastric tumors (EL-2) with a wide macroscopically negative margin of 5 cm, along with the en bloc resection of lymph nodes (D2 lymphadenectomy, EL-1), [bib_ref] Evaluation of extensive lymph node dissection for carcinoma of the stomach, Kodama [/bib_ref] [bib_ref] A meta-analysis of D1 versus D2 lymph node dissection, Seevaratnam [/bib_ref] [bib_ref] D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer, Sasako [/bib_ref] and adherent surrounding organs. Spleen and pancreas are spared (EL-2). If a splenectomy is anticipated preoperatively because of tumor adherence shown by CT, we administer pneumococcal polysaccharide, meningococcal, and Haemophilus influenzae vaccines before surgery. 4.4.2 Lymphadenectomy. [bib_ref] Evaluation of extensive lymph node dissection for carcinoma of the stomach, Kodama [/bib_ref] [bib_ref] A meta-analysis of D1 versus D2 lymph node dissection, Seevaratnam [/bib_ref] [bib_ref] D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer, Sasako [/bib_ref] Resection of lymph nodes in gastric cancer surgery can be carried out at 3 levels: 1) D1, involves removal of all nodal tissue within 3 cm of the primary tumor (perigastric nodes); 2) D2, involves D1 plus clearance of hepatic, splenic, celiac, and left gastric lymph nodes; and 3) D3, involves D2 plus omentectomy, splenectomy, distal pancreatecomy, and clearance of porta hepatis lymph nodes and para-aortic lymph nodes. 4.5 Follow up. There is no consensus regarding follow-up after gastrectomy. There is no evidence that regular intensive follow-up improves patient outcomes.