Exploring strategies in gastric cancer surgery

The scientific research presented in this thesis consists of 3 parts, in which various strategies in gastric cancer surgery were explored with the aim of improving clinical outcomes and increasing patient safety.

In part 1 the impact of preoperative staging modalities on clinical decision making was studied. The accuracy of CT-scans, 18FFDG-PET/CT-scans and staging laparoscopy were translated into initiating an appropriate clinical treatment, also considering its financial impact. The goal was to safeguard effective patient selection for gastric cancer treatment with curative intent. These results were taken into account in the revision of the national guideline for gastric cancer.

In part 2 various surgical strategies were explored to expose the heterogeneity among gastric tumors and to address the individual variation within the gastric cancer population. The goal was to acquire a more personalized approach in the gastric cancer treatment. In this context multiple types of gastrectomy, the pattern of lymph node metastases and molecular subtypes of gastric cancer were scrutinized. Additional studies were directed to evaluating surgical quality and validating multiple quality indicators in gastric cancer surgery.

Part 3 was focused on optimizing robot-assisted minimally-invasive gastrectomies. The efficacy and safety of a stepwise implementation program for robot-assisted gastrectomy was evaluated. Furthermore, the results of different surgical techniques with the operation robot were compared internationally to pursue optimal perioperative and oncological outcomes.

This thesis has contributed to improving patient selection for and the surgical quality of gastric cancer surgery, standardizing minimally-invasive gastrectomy, providing methodological recommendations for future studies and identified areas for further research.