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)

1 SU - Sorbonne Université
2 CHU Saint-Antoine [AP-HP]
3 Service de chirurgie digestive [Strasbourg-Hautepierre]
4 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
5 Service de Chirurgie Digestive et Hépatobiliaire [CHU Clermont-Ferrand]
6 CHU Estaing [Clermont-Ferrand]
7 Hôpital Edouard Herriot [CHU - HCL]
8 HCL - Hospices Civils de Lyon
9 UCBL - Université Claude Bernard Lyon 1
10 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
11 LilNCog - Lille Neurosciences & Cognition - U 1172
12 UNICANCER/CJP - Centre Jean Perrin [Clermont-Ferrand]
13 JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837
14 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
15 CRCT - Centre de Recherches en Cancérologie de Toulouse
16 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
17 EA3738 - Ciblage thérapeutique en Oncologie
18 UPCité - Université Paris Cité
19 AP-HP - Hopital Saint-Louis [AP-HP]
20 Department of Digestive and Oncological Surgery [Lille]
21 Département de chirurgie digestive
22 Chirurgie digestive [CHU Amiens]
23 SSPC - Simplification des soins chez les patients complexes - UR UPJV 7518
24 CRI (UMR_S_1149 / ERL_8252 / U1149) - Centre de recherche sur l'Inflammation
25 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
26 CHU Pitié-Salpêtrière [AP-HP]
27 Hôpital Lariboisière-Fernand-Widal [APHP]

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.

Domaines: Sciences du Vivant [q-bio]

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⟩