Gastric & Breast Cancer
DOI: 10.2122/gbc.2003.0027
Perspective
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Confirming
Hypothesis-driven Surgical Concept
and Comparing Potential Survival Benefit Expected
by D2 Surgery and Adjuvant Treatment
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Abstract |
Despite
years of research, the prognosis of Western patients
with gastric cancer, as opposed to that in Japan,
remains poor. Limited, D1 node dissection is currently
the routine clinical practice in the USA and Europe
whereas the impact of extensive, D2 dissection –standard-of-care
in Japan- and perioperative adjuvant treatment are
still remain debated.. |
Considering
current evidence available about:
• role of surgeon-volume factor
• safety of D2 dissection
• hypothesis-driven concept for a nodal stage
(N2)-specific survival benefit by D2 dissection most
recently confirmed by the Dutch randomized controlled
trial (RCT)
• effectiveness and toxicity of perioperative
(neoadjuvant, intraperitoneal, postoperative) adjuvant
treatment
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We
estimate and compare the potential impact on overall
survival by a future clinical implication of D2
surgical strategy and adjuvant treatment in patients
with gastric cancer in the USA and Europe.
Emphasis is given on the rational of localized nature
of N2 node-positive disease and the advantage of
D2 hypothesis-generating strategy to provide cure
in some of these N2 patients
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last
update: 3 February 2004 |
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