LA CONSULTA SEMANAL

1: Surg Oncol Clin N Am  2002 Jan;11(1):111-31, ix

Randomized clinical trials in gastric cancer.

Weber SM, Karpeh MS.

Section of Surgical Oncology, University of Wisconsin Hospital, Madison, USA. webers@mskcc.org

A total of 52 prospective, randomized controlled trials (RCT), published from 1975 to 2000, were reviewed for gastric cancer. The primary focus of these efforts has been the use of chemotherapy in patients with metastatic or locally advanced disease, accounting for 23 of the 52 trials. In comparison, there were only six surgical trials evaluating the extent of either primary resection or lymphadenectomy.

Publication Types:

Review

2: Gastric Cancer  2001;4(4):175-84

Adjuvant chemotherapy for gastric cancer: a comprehensive review.

Maehara Y, Baba H, Sugimachi K.

Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

The role of adjuvant chemotherapy in gastric cancer has been studied extensively over the past three decades in an attempt to further improve the prognosis of patients with gastric cancer who have undergone curative surgery. To date, no definitive conclusions have been drawn from randomized clinical trials of adjuvant chemotherapy for gastric cancer, because few studies have shown a significant positive impact on survival as compared with surgery alone. The negative results of most previous clinical studies do not necessarily mean that the adjuvant chemotherapy approach to treatment of gastric cancer does not work. Recent published reports of meta-analyses concerning adjuvant chemotherapy of gastric cancer revealed small but clear survival advantages for adjuvant therapy over surgery alone. The positive data from meta-analyses suggests that there are potential survival advantages of adjuvant chemotherapy, but this must be proven in the future by well-designed clinical trials that compare adjuvant chemotherapy with surgery alone, in which sufficient numbers of patients are enrolled and effective chemotherapeutic regimens with appropriate dose intensity are employed. Newly developed anticancer agents and/or newer therapeutic combinations or strategies (neoadjuvant chemotherapy, chemoradiotherapy, intraperitoneal chemotherapy) have the potential to benefit high-risk patients.

3: Surgery  2002 Jan;131(1 Suppl):S85-91

Therapeutic value of lymph node dissection and the clinical outcome for patients with gastric cancer.

Maehara Y, Kakeji Y, Koga T, Emi Y, Baba H, Akazawa K, Sugimachi K.

Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

BACKGROUND: While the incidence of gastric cancer differs greatly between Japan and other countries, both diagnostic and treatment modalities for patients with gastric cancer have improved in Japan. What follows is an overview of the effects of lymph node dissection for such patients. METHODS: We analyzed data on 2152 Japanese men and women with gastric cancer who underwent surgical resection from 1965 to 1995 at Kyushu University in Fukuoka, Japan. We focused on time trends of surgical management, including lymph node dissection and postoperative outcome. RESULTS: In all cases of gastric cancer, the rate of early gastric cancer increased from 18% in the first 6-year period to 57% in the last 5-year period. Extensive lymph node dissections (D2 and D3) were performed more frequently in recent years. Due to early identification of the cancer and upgraded perioperative care, both postoperative morbidity and mortality rates 30 days after surgery have decreased greatly, even in aged patients. CONCLUSIONS: Early tumor detection, standardized surgical treatment, including routine lymph node dissection, and improved perioperative management have led to increased survival time among patients with this malignancy.

Publication Types:

Review

4: Hepatogastroenterology  2001 Nov-Dec;48(42):1552-5

Gastric carcinoma in young adults.

Kokkola A, Sipponen P.

Second Dept. of Surgery, Helsinki University Central Hospital, Haartmaninkatu 4, FI-00290 Helsinki, Finland.

Approximately 10% of gastric cancer cases are found in patients younger than 41 years old. Symptoms of gastric carcinoma are not different from those in the elderly, but because of its relatively uncommon presentation in the young age group, the diagnosis may be delayed. Most of the gastric cancer cases are of diffuse type, and are associated with superficial gastritis. No association is found with intestinal metaplasia. Some gastric cancer cases may, however, develop into histologically normal stomachs. Approximately 10% of young gastric cancer patients have positive family history. In practice, the treatment of gastric cancer is not different between age groups. The same kind of survival is also seen between the age groups after operation if the same tumor stages are compared.

Publication Types:

Review

5: BMJ  2001 Dec 15;323(7326):1413-6  [Texto completo]

ABC of the upper gastrointestinal tract: Cancer of the stomach and pancreas.

Bowles MJ, Benjamin IS.

Publication Types:

Review

6: Hepatogastroenterology  2001 Sep-Oct;48(41):1504-8

Prognostic factors in patients with advanced gastric cancer treated by noncurative resection: a multivariate analysis.

Tsujitani S, Oka S, Suzuki K, Saito H, Kondo A, Ikeguchi M, Maeta M, Kaibara N.

Department of Surgery I, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago 683-8504, Japan. shu@grape.med.tottori-u.ac.jp

BACKGROUND/AIMS: The relationship between prognostic factors and survival time after noncurative gastric resection in patients with advanced gastric cancer was examined by a retrospective review of data on 364 patients. METHODOLOGY: There were 168 patients without metastasis to the liver or peritoneum (group A), 127 with peritoneal metastasis and no liver metastasis (group B), 50 with liver metastasis and no peritoneal metastasis (group C) and 19 with synchronous liver and peritoneal metastases (group D). Patients were primarily treated with the following 3 drugs: the fluorinated pyrimidines, cisplatin, and mitomycin C. RESULTS: Patients in group D had a very poor prognosis as compared with the other groups. Multivariate analysis using the Cox's proportional hazard model adjusted for sex, age, and other covariants indicated that lymph node metastasis, lymph node dissection, and fluorinated pyrimidines for group A, cisplatin for group B, and lymph node dissection for group C were independent prognostic factors. An analysis of patients excluding cases who died within 30 days after surgery revealed that lymph node dissection for group A, lymph node dissection and cisplatin for group B, and lymph node dissection for group C were independent prognostic factors. CONCLUSIONS: Treatment protocol specific for the residual disease may improve the survival of patients with advanced gastric cancer treated by noncurative resection.

7: Hepatogastroenterology  2001 Sep-Oct;48(41):1238-47

Palliation with a glimmer of hope: management of resectable gastric cancer with peritoneal carcinomatosis.

Sugarbaker PH, Yonemura Y.

Washington Cancer Institute, Washington, DC 20010, USA.

In the United States peritoneal seeding from primary gastric cancer occurs in 20-30% of patients. The diagnosis of this advanced disease is usually not provided by clinical studies prior to abdominal exploration. The surgeon is forced to make an intraoperative judgement concerning the risks and benefits of an aggressive management plan versus supportive care. A treatment strategy for this difficult group of patients has been devised and tested in phase II studies. It utilizes extended gastrectomy plus peritonectomy to maximally cytoreduce tumor combined with perioperative intraperitoneal chemotherapy. The perioperative intraperitoneal mitomycin-C chemotherapy is heated to 42 degrees C and manually distributed to provide uniform treatment to all peritoneal surfaces and the resection site. Early postoperative intraperitoneal 5-fluorouracil is gravity distributed. The pharmacologic parameters have been established. Relevant clinical information was collected in this review. Five-year survival of these patients in whom a complete cytoreduction was possible has been observed and a prolonged median survival occurs. Gastrectomy with peritonectomy to eliminate all visible implants combined with perioperative intraperitoneal chemotherapy should be considered in all patients with primary gastric cancer and peritoneal carcinomatosis.

Publication Types:

Review

8: Surg Oncol Clin N Am  2001 Oct;10(4):833-54, ix

Principles of surgical radicality in the treatment of gastric cancer.

Bozzetti F.

International Gastric Cancer Association, Milan, Italy. dottfb@tin.it

The aim of curative surgery is to perform an RO resection, that is, the volume of resection should encompass the tumor volume in toto and fall in healthy margins. This means maintaining a transection margin 6 cm from the tumor and removing neighboring organs altogether if involved by the tumor. With regard to lymphadenectomy, the adequate number to be retrieved which allows a proper staging, and probably the optimal results, is about 25 lymph nodes.

Publication Types:

Review

9: Drugs  2001;61(11):1545-51

Recent advances in the treatment of gastric cancer.

Sun W, Haller DG.

University of Pennsylvania Cancer Center, Philadelphia, Pennsylvania 19104, USA.

Gastric cancer is one of the most common cancers in the world. The prognosis of the disease is poor, with only 40% of patients eligible to undergo potentially curative surgery. Even for those patients who undergo a complete resection, the rate of recurrence is very high. Extensive studies of multidisciplinary adjuvant treatment have been conducted seeking to improve the cure rates in the past two decades. The benefit of D2 dissection is still controversial and is undergoing prospective evaluation. Preliminary results from the United States Gastrointestinal Intergroup study, a well designed trial, have shown overall survival benefit of postoperative chemoradiation therapy. Neoadjuvant chemotherapy or chemoradiation is under active study in order to increase the number of patients to undergo potential curative surgery. Although many chemotherapy regimens have been developed recently, only modest clinical efficacy has been demonstrated for advanced metastatic disease. So far, there is no single regimen considered to be standard.

Publication Types:

Review

10: Surg Oncol  2000 Jul;9(1):35-41

Cancer of the esophagogastric junction.

Stein HJ, Feith M, Siewert JR.

Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universitat Munchen, Munich, Germany. stein@nt1.chir.med.tu-muenchen.de

In the Western world, there has been an alarming rise in the incidence and prevalence of adenocarcinoma arising at the esophagogastric junction during recent decades. Epidemiological, clinical and pathological data support a sub-classification of adenocarcinomas arising in the vicinity of the esophagogastric junction (AEG) into adenocarcinoma of the distal esophagus (Type I), true carcinoma of the cardia (Type II) and subcardial carcinoma (Type III). While most, if not all, adenocarcinomas of the distal esophagus arise from areas with specialized intestinal metaplasia, which develop as a consequence of chronic gastroesophageal reflux, the etiology and pathogenesis of true carcinoma of the gastric cardia and subcardial gastric cancer is not clear at present. Although a subgroup of true carcinomas of the gastric cardia may also develop within short segments of intestinal metaplasia at the esophagogastric junction, a causal relation between these tumors and gastroesophageal reflux has been difficult to establish. Irrespective of the etiology, a complete removal of the primary tumor and its lymphatic drainage has to be the primary goal of any surgical approach to adenocarcinoma of the esophagogastric junction. Our experience in the management of more than 1000 such patients during the past 18 years suggests that an individualized therapeutic strategy oriented by tumor type and stage results in survival rates superior to those reported with a more indiscriminate approach. This individualized strategy prescribes a transmediastinal esophagectomy with lymphadenectomy in the lower posterior mediastinum and along the celiac axis for Type I tumors, extended total gastrectomy with transhiatal resection of the distal esophagus and D2 lymphadenectomy for Type II and Type III tumors, a limited resection of the esophagogastric junction and distal esophagus with interposition of a pedicled jejunal segment for uT1N0 tumors, and neoadjuvant chemotherapy followed by resection for uT3/T4 tumors. Extensive preoperative staging is essential to allow correct selection of the appropriate therapeutic strategy using this tailored approach.

Publication Types:

Review

11: Surg Oncol  2000 Jul;9(1):23-30

Modern staging in gastric cancer.

Tschmelitsch J, Weiser MR, Karpeh MS.

Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA.

Publication Types:

Review

12: Surg Oncol  2000 Jul;9(1):17-22

The management of early gastric cancer.

Sano T, Katai H, Sasako M, Maruyama K.

Gastric Surgery Division, National Cancer Center Hospital, Tokyo, Japan.

Publication Types:

Review

13: Surg Oncol  2000 Jul;9(1):13-6

Gene therapy for gastric cancer: problems and prospects.

Steele RJ, Lane DP.

Department of Surgery and Molecular Oncology, University of Dundee, Scotland, UK.

Publication Types:

Review