Preoperative chemotherapy for gastric cancer: a prospective study with at least 1 year follow-up.

Abstract

Despite its declining incidence gastric cancer (GC) continues to be an important cause of death in the Western world (Papaioannou 1981 b). As a rule, the disease presents itself late, not being amenable to possible cure by presently available means. In a recent report, for example, among 192 patients who were explored, 80 operations were considered to be “curative” and only 7 were “early” cases. The overall 5-year survival in this series was 5.6% (Scott et al. 1985). It is obvious that surgery alone is not sufficient to deal with this disease, irrespective of how radical it may be. Adjuvant chemotherapy in a variety of schemes and schedules tested prospectively has also been unsuccessful (Rake et al. 1976; Kingstone et al. 1978; Dent et al. 1979). On the basis of the above evidence, 5 years ago we suggested that the possible reasons for our failure to improve end results, even in relatively early cases of GC, may be the early micrometastatic dissemination of the disease, which may, in fact, become enhanced during gastrectomy. This was considered likely as a result of the immunosuppression due to surgical stress and anesthesia as well as the influence of other perioperative tumor-promoting events modifying the subsequent course of the disease. To minimize or prevent this occurrence, was suggested that GC must be conceptually accepted as a systemic disease and treated initially by systemic chemotherapy (Papaioannou 1981b). Unfortunately, the idea has been unattractive to surgeons and the formation of a collaborative group to gather a sizeable group of patients has not become possible. We are, therefore, reporting here a small prospectively randomized series of GC patients from one surgical service alone, where the principle of preoperative chemotherapy (PrCh) was tested and all patients have been followed for at least 1 year.