Cancers of the gastrointestinal tract form a major component of the workload of a busy general surgeon or a surgical oncologist. Despite advances in chemotherapy and radiotherapy, surgery still remains the sina qua non in the management of GI tract cancers. Changing trends and differing opinions, based on current surgical research dominate the management of lymph node dissections.
1 Investigative work on sentinel node biopsy (SNLB) in oesophagus, stomach and colon cancers has been reported as an analogy to breast cancer.
2 Dissection and removal of normal non-infiltrated nodes in the GI tract do not produce the kind of morbidity as seen in breast cancers and hence the study of SNLB in GI tract cancers can, at best, be seen as an academic exercise.
Appropriate removal of draining lymph nodes not only allows precise staging but it is of great help in planning adjuvant therapy and determining prognosis in a given patient. None of the advances, either in molecular biology or chemotherapy have changed the standard surgical approach to GI cancers. If at all there is a shift, it is related to the appropriate interpolation of multidisciplinary approach, and the extent of surgery at various sites in the GI tract.
