Surgical management of gastric cancer: R1, R2 or R3. When, how and why? [TERAPIA CHIRURGICA DEL CARCINOMA GASTRICO: R1, R2 O R3. QUANDO, COME E PERCHE?]

Abstract In the surgical treatment of gastric cancer there are controversies on whether patients with carcinoma in the gastric antrum should undergo a total or sub-total gastrectomy. Moreover, the degree of lymph node dissection remains a difficult and challenging problem. On the basis of our experience and on revision of the literature, we have reached the following conclusion: with the advent of staplers and with the improvements made in preoperative artificial nutrition there is not a significant difference between total gastrectomy and sub-total distal gastrectomy in terms of immediate postoperative morbidity and mortality; long-term survival birded to the so called 'oncological radicality' depends not so much on the extension of the resection (sub-total gastrectomy or total gastrectomy of the carcinoma of the gastric antrum) but rather on the lymphadenectomy provided that it is extended beyond the metastatic lymph nodes (R > N). Presently the amount of lymph node involvement (N1, N2, N3) can be only hypothesised on the basis of the extension of primary tumour (T), thus orientating the extension of lymph node dissection (R1, R2, R3).