This year, the results of the ACTS-GC trial were published, providing definitive evidence of the effectiveness of adjuvant chemotherapy using TS-1 in patients with stage II and III gastric cancer except early gastric cancer. (52) As a result, most of the Japan Clinical Oncology Group (JCOG) trials were revised and restarted. One more important result of the JCOG trial 9501 was arrived at and will be published soon. Using the data of the trial, 2 papers were published: one, on the influence of overweight on surgical complications, (50) and the other, on risk factors for paraaortic lymph node metastasis in gastric cancer. (51) Several JCOG trials are currently in progress.
2) JCOG trial 0501: A phase III trial to examine the efficacy of neoadjuvant chemotherapy using TS-1 + CDDP in patients with scirrhous gastric cancer and large stage III gastric cancer against a preceding surgery arm. Both arms were followed by adjuvant chemotherapy with S-1.
2) JCOG trial 0302: A feasibility study for sentinel node navigation surgery for early gastric cancer. However, this trial has been terminated because of a high false-negative rate, and it should be continued or not is being discussed.
● T. Kinoshita ●
Hepatobiliary and pancreatic cancers:
1) Hepatocellular carcinoma
A retrospective analysis was undertaken to evaluate the efficacy of reduction hepatectomy for advanced HCC. The results indicated that ICG R15 ≧ 15%, preoperative AFP ≧ 2000 ng/ml, and tumor reduction rate <98% were the predictive factors (42).
2) Duodenal neoplasms
Pancreas-sparing duodenectomy (PSD) represents an attractive operation for benign or premalignant duodenal disease. However, the use of PSD for malignancies is controversial. Analysis of 16 patients who underwent PSD for duodenal neoplasms validated 3 categories of indications for PSD: early-stage neoplasms, isolated duodenal neoplasms in high-risk patients, and duodenal involvement from adjacent organ malignancies (43).
3) Pancreatic cancer
Although extended lymphadenectomy and intraoperative radiation therapy (IORT) has been used for the treatment of pancreatic cancer, their efficacy remains controversial. Therefore, a retrospective analysis was undertaken. Neither extended lymphadenectomy nor IORT showed a survival advantage in patients with resectable pancreatic adenocarcinoma (44).
4) Intraductal papillary mucinous neoplasm
An increasing number of intraductal papillary mucinous neoplasms of the pancreas have been reported in recent years. Patients with adenoma, noninvasive carcinoma, and minimally invasive carcinoma showed a favorable survival. In contrast, invasive intraductal papillary mucinous carcinoma was associated with poor survival regardless of the margin status (45).
5) Hepatic metastasis of colorectal carcinoma
Hepatic and pulmonary metastases may be detected sequentially or simultaneously in patients with colorectal carcinoma. A retrospective analysis indicated that multiple resections for hepatic and pulmonary metastases are safe and effective. No mortality was observed, and the overall survival after the first metastasectomy for the second organ was 58% (46).
● M. Konishi ●