Gastric Surgery
Introduction
In the Hospital East, there is no independent Gastric Surgery Group. Surgeons from the Hepatobiliary and Pancreatic Surgery Group and Colorectal Surgery Group operate on patients with gastric and duodenal malignancies including adenocarcinomas, myogenic tumors and other neoplasias.
Routine Activities
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 p. m., a film conference on gastrointestinal malignancy is held, where treatment decisions are discussed especially for surgical cases among medical oncologists, endoscopists, radiologists and surgeons. Operative findings and pathological findings of resected specimens are reported in this conference. This conference is held in English when any foreign guest doctor is present.
Every Wednesday from 5:00 to 6:00 p. m., a joint conference for malignant diseases of abdominal digestive organs is held, wherein newly admitted patients and discharged patients are introduced and treatment strategies are reconfirmed. New treatment strategies are also discussed in this conference.
Research Activities
1. Assessment of Combined Modalities
1) JCOG trial 9206: A randomized controlled trial on adjuvant chemotherapy for curatively resected T3, T4 tumors was finished this year. This trial compares surgery alone with surgery plus adjuvant chemotherapy, using CDDP, 5FU and UFT. We are waiting for the results.
2) NSAS-GC (National surgical adjuvant Study of Gastric Cancer) trial: A trial to evaluate the effectiveness of adjuvant chemotherapy using UFT. This trial compares surgery alone with surgery plus adjuvant chemotherapy for patients with a T2 tumor and n1 or n2.
3) Neoadjuvant CTx: a one arm prospective trial of neoadjuvant chemotherapy for resectable type 4 (scirrhous) gastric cancer, using 2 courses of FAMTX, was terminated this year when 20 cases were collected and analyzed tentatively. Tentative analysis of these 20 cases showed an unimproved 2-year survival rate, low-response rate (15%) and relatively severe toxicity even though improved resectability was achieved and the operative procedure was safe.
2. Assessment of Surgical Procedures
1) JCOG trials 9501 and 9502: 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 laparoscopic staging for patients with suspected serosal invasion preoperatively. Open laparotomy is avoided when laparoscopic examination reveals definite incurable factors like P2, P3, H2 and H3. So far more than 30 patients have received laparoscopic staging and in 7 patients, we could avoid unnecessary laparotomy. Diagnostic reliability of laparoscopy is evaluated by comparing with staging by open laparotomy.
New Developments
In June 1998, we started a new trial (JCOG trial 9701) to evaluate the effectiveness of adjuvant chemotherapy (CDDP+5FU) including IP chemotherapy using IP port in the abdomen for curatively resected P1, P2 or cy (+) patients. The trial consists of surgery alone arm and an arm with chemotherapy.
Statistics
| Primary gastric cancer | 205 |
| Recurrent gastric cancer | 7 |
| Gastric tumors other than cancer | 3 |
| Others | 7 |
| Total | 222 |
| Distal gastrectomy | 130 |
| Total gastrectomy | 47 |
| Proximal gastrectomy | 9 |
| Local excision | 3 |
| Others | 21 |
| Unresected | 12 |
(T. Kinoshita)
