[Stage-adapted radical principles in XXXX ].

@entity1 @entity5108 @entity41 @entity5 @entity189 @entity3 @entity356
The aim of any surgical approach to @entity356 should be a complete resection with no @entity41 left behind, that is, a R0-resection according to UICC. Complete @entity5 resection in this respect refers to the @entity5 as well as to the lymphatic drainage and requires an adequate safety margin. The indications for surgical therapy of @entity356 and the choice of procedure should consequently be guided by the @entity5 stage. This requires accurate preoperative staging, which can today be achieved with endoscopic ultrasonography and surgical laparoscopy. @entity356 stage @entity5108 ( @entity189 ) can be cured by local excision. In @entity1 with @entity5 Stages IB ( @entity189 ), II, and IIIA, lymph node @entity3 are common. Based on the available data, this group of @entity1 benefits from radical resection and D2 lymph node dissection. The overall 5-year survival rate of 50% for the large number of @entity1 undergoing gastric resection for @entity5 seems to demonstrate convincingly the value of extended lymphadenectomy. In @entity1 with advanced @entity356 , that is, @entity5 stages IIIB and IV, a complete @entity5 removal usually can not be achieved by surgical dissection. Neoadjuvant therapeutic modalities should consequently be assessed in these @entity1 . Based on @entity5 location and growth pattern, a total gastrectomy is the procedure of choice in @entity1 with @entity356 . A subtotal gastrectomy may be performed in @entity1 with @entity5 of the distal third and "Laurens intestinal type" growth pattern. The distal site of the main lesion must be investigated carefully to ensure that incidental concomitant lesions are not overlooked. Depending on the individual @entity5 situation, the gastrectomy can be extended toward varying portions of the distal esophagus or the pancreas, preserving splenectomy and resection of the retroperitoneal lymph nodes. The high incidence of locoregional recurrences and distant @entity3 after curative surgery for @entity356 calls for improved locoregional control and systemic adjuvant treatment.
