Current best practices and rationalistic perspectives in causation-based prevention, early detection and multidisciplinary treatment of breast and gastric cancer


Gastric & Breast Cancer
DOI: 10.2122/gbc.2003.0027

Perspective

Confirming Hypothesis-driven Surgical Concept
and Comparing Potential Survival Benefit Expected by D2 Surgery and Adjuvant Treatment

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

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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Online ISSN : 1109 - 7647
   Print ISSN : 1109 - 7655

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last update: 3 February 2004