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Surgical management of gastric adenocarcinoma. Official expert recommendations delivered under the aegis of the French Association of Surgery (AFC)

T. Voron 1, 2 B. Romain 3 D. Bergeat 4 J. Veziant 5 J. Gagniere B. Le Roy 6 A. Pasquer 7, 8, 9, 10 C. Eveno 11 S. Gaujoux 1 D. Pezet 12 C. Gronnier 13, 14 D. Collet J. H. Lefevre 1, 2 N. Carrere 15, 16 G. Poncet 7, 8, 9, 10 O. Glehen 17 D. Goere 18, 19 G. Piessen 20 B. Meunier 4 J-J Tuech C. Brigand 21 N. Regenet Jean-Marc Regimbeau 22, 23 S. Msika 24, 25 M. Karoui 26 M. Pocard 27
Abstract : Gastric adenocarcinoma (GA) is the 5th most common cancer in the world; in France, however, its incidence has been steadily decreasing. Twenty-five experts brought together under the aegis of the French Association of Surgery collaborated in the drafting of a series of recommendations for surgical management of GA. As concerns preoperative evaluation and work-up, echo-endoscopy aimed at clarifying lymph node status should be performed in all candidates for surgical resection and exploratory laparoscopy in cases of GA cT3/T4 and/or N+ for peritoneal carcinomatosis. On the other hand, PET-scan should not be performed systematically, but only when the other modalities for diagnosis prove insufficient. Laparotomy remains the route of choice to achieve total or partial gastrectomy with D2 lymph node lymphadenectomy for advanced lesions (> T2N0). To limit the risk of dumping syndrome and esophageal reflux and as a way of reestablishing continuity, construction of a jejunal pouch on Roux-en-Y following total gastrectomy is recommended. In cases of peritoneal carcinosis in GA with a low peritoneal cancer index (PCI) (<7) in a patient in good general condition whose disease is controlled by chemotherapy, macroscopically complete cytoreduction with intraperitoneal hyperthermal chemotherapy will probably be required, and it will have to take place in an expert center. Only in the event of Child A cirrhosis may gastrectomy with D2 lymphadenectomy be considered. Palliative gastrectomy or surgical bypass for distal stomach obstruction in a patient in good general condition may also be envisioned. (C) 2020 Published by Elsevier Masson SAS.
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Soumis le : jeudi 3 mars 2022 - 11:57:23
Dernière modification le : vendredi 20 mai 2022 - 11:06:42

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T. Voron, B. Romain, D. Bergeat, J. Veziant, J. Gagniere, et al.. Surgical management of gastric adenocarcinoma. Official expert recommendations delivered under the aegis of the French Association of Surgery (AFC). Journal of Visceral Surgery, 2020, 157 (2), pp.117-126. ⟨10.1016/j.jviscsurg.2020.02.006⟩. ⟨hal-03595657⟩

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