Treatment Strategies for Far Advanced Gastric Cancer

Yutaka Yonemura

Department of Surgery II, School of Medicine, Kanazawa University

For the survival improvement of patients with far advanced gastric cancer, a strategy combined with chemotherapy and surgical cytoreduction is important. Neoadjuvant chemotherapy increased the ratio of curative resection, and improved the survival of patients with locally advanced disease (T4, N3 and/or P1). However, patients with metastatic disease having liver metastasis, peritoneal dissemination or paraaortic lymph node metastasis had poor prognosis, except for patients, who underwent complete resection of metastatic foci. Peritoneal dissemination resists to the systemic chemotherapy because of the existence of blood-peritoneal barrier. Consequently, this type of metastasis have been treated with intraperitoneal chemohyperthia. The response rate after this therapy was 32% with a 5-year survival rate of 12%. However, the survival of patients with intraperitoneal residual disease could not be improved even after this therapy. To remove all the peritoneal dissemination, a novel, surgical treatment called peritonectomy was developed. The survival after peritonectomy showed the best prognosis than that after hyperthermia or systemic chemotherapy. These results indicate that the patients prognosis is closely associated with residual tumor burden and that the degree of surgical cytoreduction influences the patients survival with advanced gastric cancer.

Key words
gastric cancer, peritonectomy, hyperthermia

Reprint requests
Yutaka Yonemura Department of Surgery II, School of Medicine, Kanazawa University
13-1 Takaramachi, Kanazawa, 920 JAPAN

Accepted
May 21, 1997

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