Gastric Surgery
Introduction
There is no independent gastric surgery group at NCCHE. Surgeons in the Upper Abdominal Surgery Division and Pelvic Surgery Division operate on patients with gastric and duodenal malignancies, including adenocarcinomas, myogenic tumors, and other neoplasms.
Routine Activities
In close
cooperation with surgeons in the two abdominal surgery divisions, four to
five patients are operated on every week.
A film
conference for the gastrointestinal malignancy cases is held every Monday,
where treatment decisions are discussed, especially for surgical cases, among
medical oncologists, endo-scopists, radiologists, and surgeons. Operative
findings and pathological findings of resected specimens are reported during
this conference. This conference is held in English when any foreign guest
doctor is present.
A joint conference for malignant diseases of the abdominal digestive organs is held every Wednesday, 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)NSAS-GC (National Surgical Adjuvant
Study of Gastric Cancer):
A trial to evaluate the effectiveness of adjuvant chemotherapy using UFT. This trial compares surgery alone with surgery plus adjuvant chemotherapy for patients with T2 tumors and n1or n2 patients.
2)JCOG trial 9701:
A randomized trial to evaluate the effectiveness of adjuvant chemotherapy (CDDP+5FU) including IP chemotherapy using an IP port in the abdomen for curatively resected P1, P2, or cy(+) patients. The trial consists of surgery alone versus surgery with chemotherapy. Because fewer patients entered into this trial than expected, we stopped the trial.
2. Assessment of surgical procedures
1)JCOG trials 9501 and 9502:
Trial 9501 is a randomized trial to compare standard lymph node dissection (D2) with super-extended dissection (D4). Trial 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 quality of life will be evaluated.
2)Laparoscopic staging:
This trial involves laparoscopic staging for patients with suspected serosal invasion preoperatively. Open laparotomy is avoided when laparoscopic exami-nation reveals definite incurable factors such as P2, P3, H2, and H3. So far more than 50 patients have received laparoscopic staging, and in 16 of these patients we were able to avoid unnecessary laparotomy. The diagnostic reliability of laparoscopy is evaluated compared with staging by open laparotomy.
New Developments
In 1999, we started two pilot trials to confirm their feasibility. One is neoadjuvant chemotherapy for resectable type 4 (scirrhous) gastric cancer, using TS-1. The other is a trial for adjuvant chemotherapy also with TS-1 for curatively resected (curability B) gastric cancer patients.
|
Number
of Patients in 1999 |
|
|
Primary gastric cancer |
196 |
|
Recurrent gastric cancer |
9 |
|
Gastric tumors other than cancer |
8 |
|
Others |
9 |
|
Total |
222 |
|
Operative
Procedures |
|
|
Distal gastrectomy |
121 |
|
Total gastrectomy |
52 |
|
Proximal gastrectomy |
13 |
|
Local excision |
13 |
|
Others |
15 |
|
Unresected |
8 |
|
Total |
222 |
(T. KINOSHITA)
