Yu W
Department of Surgery, Kyungpook National University, Taegu 700-721, South Korea.
Eur J Surg Oncol. 2006 Aug;32(6):655-60. doi: 10.1016/j.ejso.2006.03.010. Epub 2006 Apr 18.
Because patients with advanced gastric cancers have less than 50% chance of cure after R0 resection, the need for an adjuvant treatment to eradicate residual microscopic disease is clear. The major treatment strategy during the last decades has been postoperative systemic therapy. The results of published trials were reviewed. And, perioperative intraperitoneal chemotherapy as an adjuvant to potentially curative surgery was evaluated.
A literature search on this topic was performed for articles relating to clinical trials using adjuvant chemotherapy in the management of gastric cancer. Subset analyses of Taegu's phase III trial of early postoperative intraperitoneal chemotherapy were performed.
Even after extended lymphadenectomy, the peritoneal surface and resection site had a high incidence of recurrence. Postoperative systemic chemotherapy treatment regimens available in the past showed no major improvement in survival. One of new approaches currently undergoing study was intraperitoneal chemotherapy given in the perioperative period. The Taegu data showed this treatment reduced the incidence of peritoneal recurrence and thereby improved the survival rate after potentially curative surgery for gastric cancer.
The eradication of micrometastatic foci in the peritoneal cavity can be achieved by the perioperative intraperitoneal administration of chemotherapeutic agents. Patients with serosa-positive gastric cancer are most likely to benefit from adjuvant intraperitoneal chemotherapy.
由于晚期胃癌患者行R0切除术后的治愈机会不到50%，因此显然需要辅助治疗以根除残留的微小病灶。过去几十年的主要治疗策略是术后全身治疗。对已发表试验的结果进行了综述。并且，评估了围手术期腹腔内化疗作为潜在根治性手术辅助治疗的效果。
针对该主题进行文献检索，查找与在胃癌管理中使用辅助化疗的临床试验相关的文章。对大邱的早期术后腹腔内化疗III期试验进行了亚组分析。
即使进行了扩大淋巴结清扫，腹膜表面和切除部位的复发率仍很高。过去可用的术后全身化疗方案在生存率方面没有显著改善。目前正在研究的新方法之一是围手术期腹腔内化疗。大邱的数据表明，这种治疗降低了腹膜复发的发生率，从而提高了胃癌潜在根治性手术后的生存率。
围手术期腹腔内给予化疗药物可实现腹腔内微转移灶的根除。浆膜阳性胃癌患者最有可能从辅助腹腔内化疗中获益。
