演題抄録

臓器別シンポジウム

開催概要
開催回
第51回・2013年・京都
 

Multimodal treatment in localized gastric cancer in Europe

演題番号 : OS11-1

[筆頭演者]
Cornelis J.H. van de Velde:1 

1:Dept. of Surgery, LUMC, Netherlands

 

In the Dutch Gastric Cancer Group Trial (DGCT), 711 patients underwent a D1 or D2 gastrectomy. Initial results showed an increased morbidity (25% versus 43%) and mortality (4% versus 10%) in the D2 group, which could be partially attributed to the higher number of splenectomies and pancreatectomies in this group, while there was no significant difference in 11-year survival rates (30% versus 35%). However, a recent update revealed that gastric cancer-related death rate after a median follow-up of 15.2 years was significantly higher in the D1 group (48%) compared with the D2 group (37%), indicating that a D2 dissection is the recommended type of surgery in Western countries.In Europe, now after extensive debates on the role of extent of lymph node dissection, D2 has been accepted and recommended in guidelines with removal of at least 15 lymph nodes for adequate staging. On the initiative of the European Society of Surgical Oncology an upper GI-audit with initially 6 countries was initiated (EURECCA Upper GI) to monitor and give feedback on the adequacy of resection and multimodality treatment. Results to be presented helped the centralization of surgery in high volume centers to attain optimal results (www.canceraudit.eu).The important question that needs to be answered is whether postoperative chemoradiotherapy improves survival and/or locoregional control in patients receiving neoadjuvant chemotherapy followed by a D2 gastric resection. We therefore conduct a prospective randomized multicenter phase III trial (CRITICS; ChemoRadiotherapy after Induction chemoTherapy In Cancer of the Stomach) addressing this important question. To ascertain patient compliance and improve patient selection/treatment tailoring, we incorporated validated prognostic and predictive tests, such as the Maruyama index Results will be presented as well as recommendations for optimalisation of gastric cancer treatment in Europe.

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