In close cooperation with surgeons in the two abdominal surgery groups, three to five (average four) patients are operated on every week. Every Monday from 4:30 to 5:30 PM, a film conference focusing on gastrointestinal malignancy is held, and treatment decisions especially for surgical cases are discussed among medical oncologists, endoscopists, radiologists and surgeons. Operative and pathological findings of resected specimens are reported in this conference. This conference is held in English whenever foreign visiting doctors are present.
Every Wednesday from 5:00 to 6:00 PM, a joint conference on malignant diseases of the abdominal digestive organs is held, wherein newly admitted patients and discharged patients are introduced and treatment strategies for patients are reconfirmed. New treatment strategies are also discussed in this conference.
1. Assessment of combined modalities
1) JCOG trial 9206: A randomized controlled trial on adjuvant chemotherapy for curatively resected T3, T4 tumors is ongoing. This trial compares surgery alone with surgery plus adjuvant chemotherapy, using CDDP, 5FU and UFT.
2) Neoadjuvant CTx: A one arm prospective trial of neoadjuvant chemotherapy for resectable type 4 (scirrhous) gastric cancer, using 2 courses of FAMTX, is also underway.
2. Assessment of surgical procedures
1) JCOG trials 9501 and 9502: Two more trials are ongoing. One (9501) is a randomized trial to compare standard lymph node dissection (D2) with super-extended dissection (D4). The other (9502) is also a randomized trial comparing two commonly used approaches for gastric cancer invading the esophagus. In these trials, the 5-year survival rate is the primary endpoint and postoperative morbidity, mortality and QOL will be evaluated.
2) Laparoscopic staging: The last trial is laparo-scopic staging for patients with suspected serosal invasion preoperatively. Open laparotomy is avoided when laparoscopic examination reveals definite factors indicative of incurability such as P2, P3, H2 and H3. The diagnostic reliability of laparoscopy is evaluated in comparison with staging by open laparotomy.
In October 1997, we started a new trial to evaluate the effectiveness of adjuvant chemotherapy using UFT under the control of NSAS-GC (National Surgical Adjuvant Study of Gastric Cancer). This trial compares surgery alone with surgery plus adjuvant chemotherapy for patients with T2 tumors and n1 or n2.
|Primary gastric cancer||203|
|Recurrent gastric cancer||2|
|Gastric tumors other than cancer||3|
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