Staging and Surgical Approaches in Gastric Cancer

Guideline Objective

To develop recommendations on the optimal surgical management of gastric cancer in Ontario.

Patient Population

These recommendations apply to adult men and women with Stage I to IV gastric cancer who are being considered for surgery. Gastroesophageal junction tumours and early gastric cancers are excluded because they require additional considerations.

Intended Guideline Users

Intended users of this guidance document are surgeons, gastroenterologists, medical oncologists, radiation oncologists, and the multidisciplinary team who treat gastric cancer.

Research Questions

1. What is/are the optimal techniques(s) to adequately stage gastric cancer?
2. What is the optimal technique of gastric cancer surgery with curative intent with respect to:
   
   1. D2 lymph node dissection?
   2. D1 lymph node dissection?
   3. The minimal number of lymph nodes needed to be dissected for curative-intent resection?
   4. The minimal gross margin for curative-intent resection?
   5. Laparoscopic versus open resection?
3. What are the indications for surgery for Stage IV gastric cancer in:
   
   1. Asymptomatic patients?
   2. Symptomatic patients?
4. What is the relationship between surgical volumes and outcomes?