With regard to operative treatment of gastric carcinoma, which of the following statements is/are correct?

c. Extended lymphadenectomy including nodes along the aorta and esophagus has not been shown to improve survival in North American trials

d. Long-term survival is rare if adjacent organs must be resected to achieve local control

In gastric cancer, microscopic involvement of the resection margin by tumor cells is associated with poor prognosis. In contrast to colon cancer, gastric cancer frequently demonstrates extensive intramural spread. Retrospective studies suggest that a line of resection 6 cm from the tumor mass is necessary to ensure a low rate of anastamotic recurrence. The value of extended lymphadenectomy in the treatment of gastric adenocarcinoma is controversial. The largest favorable experience has been reported by Japanese surgeons, where retrospective studies have suggested an improvement of approximately 10%, stage for stage, for patients with advanced disease. The benefits of extensive lymphadenectomy have not been confirmed in western countries

Histologically positive lymph nodes are frequently present in the splenic hilum and along the splenic artery, and routine splenectomy has been practiced in some centers. Prophylactic splenectomy has not been demonstrated to improve outcome for similarly staged patients. Resection of adjacent organs may be required for local control if direct invasion has occurred. In this circumstance, operative morbidity is increased, and long-term survival is rare.