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Preoperative Chemotherapy in Gastric Cancer

  • H. Wilke
  • H. J. Meyer
  • U. Fink
Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 142)

Abstract

Even with extended surgery, including systematic lymphadenectomy of the lymph node compartment II, only half of the patients with locally advanced gastric cancer (LAGC) — which comprises stages IIIA, IIIB, and IV — undergo macroscopic and microscopic tumor-free resection (i.e., RO resection, according to UICC 1987/AICC 1988). An improvement in this situation is best accomplished by preoperative treatment modalities to increase the RO resection rate and by preoperative and postoperative treatment to reduce local recurrences and distant metastases. For LAGC, which includes approximately two thirds of patients with locoregionally confined tumors, preoperative chemotherapy (CTx) represents a promising approach. Among a group of patients with surgically or clinically staged unresectable LAGC, approximately half underwent RO resection after downstaging induced by active CTx. The long-term survival of these patients seems to be improved. Even in patients who had primarily unresectable tumors as defined by explorative laparotomy, the long-term survival was about 20% after preoperative CTx and subsequent surgery. Based on these experiences, randomized trials investigating preoperative CTx versus surgery alone are clearly needed to define whether such an approach has an impact on RO resection rates and survival of patients with LAGC. Preconditions for such trials are clinical staging procedures, including endoscopie ultrasonography (T category) and surgical laparoscopy plus lavage (excluding peritoneal carcinomatosis), and a standardized surgical procedure.

Keywords

Gastric Cancer Advanced Gastric Cancer Preoperative Chemotherapy Peritoneal Carcinomatosis Explorative Laparotomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Berlin Heidelberg 1996

Authors and Affiliations

  • H. Wilke
    • 1
  • H. J. Meyer
    • 2
  • U. Fink
    • 3
  1. 1.Department of Internal Medicine (Cancer Research)Essen University Medical SchoolEssenGermany
  2. 2.Department of SurgeryHanover University Medical SchoolHanoverGermany
  3. 3.Department of SurgeryTechnical University of MunichMunichGermany

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