Is surgical treatment the first choice for gastric cancer?

Due to the improvement of gastric cancer diagnosis and treatment, the indications for surgery have been expanded accordingly. Currently, except for patients with huge primary lesions, extensive metastasis to abdominal organs, and cachexia with bloody ascites, as long as the patient's general condition permits, even if there are supraclavicular lymph node metastases and metastatic nodules in the liver, surgical treatment should be sought to remove the primary lesion and alleviate symptoms.

Types of surgery include:

① Radical resection. There are two types of radical resection: radical resection and extended radical resection. In the former, the resection range should include the primary lesion, together with 2/3 or 4/5 of the distal stomach, the entire greater and lesser omentum, the first part of the duodenum and regional lymph nodes, and the locally infiltrated organs. The stomach or duodenum should be free of cancer cells and residual cancer. In the latter, in addition to the above, the resection range should also include the removal of the entire stomach or the adjacent invaded transverse colon, left lobe of the liver, spleen, pancreatic body and tail, and lymph nodes beside the left cardia and splenic blood vessels.

② Palliative resection. When gastric cancer has extensively metastasized to the peritoneum or lymph nodes, and the primary tumor can be removed, and the patient can generally tolerate the surgery, palliative gastrectomy can be performed. This surgery can alleviate the patient's poisoning symptoms and eliminate complications such as obstruction, bleeding or perforation caused by the cancer. Postoperative chemotherapy and traditional Chinese medicine treatment can prolong the patient's survival.