D2 Gastrectomy For Gastric Cancer Research Articles

Sarcopenia is Associated with Postoperative Complications in Patients Undergoing D2 Gastrectomy for Gastric Cancer

Sarcopenia is Associated with Postoperative Complications in Patients Undergoing D2 Gastrectomy for Gastric Cancer

Early Postoperative Outcomes of Modified D2 Gastrectomy for Gastric Cancer in a Tertiary Hospital

Early Postoperative Outcomes of Modified D2 Gastrectomy for Gastric Cancer in a Tertiary Hospital

Comparison of short-term outcomes of robotic-assisted and laparoscopic-assisted D2 gastrectomy for gastric cancer: a meta-analysis.

AimThe aim of the study was to compare the outcomes of robot-assisted (RAGD2) and laparoscopy-assisted gastrectomy with D2 lymphadenectomy (LAGD2) for patients with gastric cancer.Material and methodsRelevant articles published up to September 2020 were searched. The weighted mean difference (WMD) was used to pool continuous variables, while risk ratio (RR) was calculated for dichotomous outcomes.ResultsRAGD2 required a longer operating time (WMD = 29.78, 95% confidence interval (CI): 15.97–43.59) and had less operative blood loss (WMD = −31.93, 95% CI: −44.03 to −19.83), shorter time to first flatus (WMD = −0.13, 95% CI: −0.22 to −0.04), shorter time to liquid diet (WMD = −0.20, 95% CI: −0.28 to 0.12), and fewer severe complications (RR = 0.62, 95% CI: 0.43–0.90) and overall complications (RR = 0.75, 95% CI: 0.62–0.91) than LAGD2.ConclusionsRAGD2 could be beneficial in reducing operative blood loss and postoperative complications relative to LAGD2.

Laparoscopic D2 Gastrectomy for Gastric Cancer: Mid-Term Results and Current Evidence.

Although the first laparoscopic gastrectomy was performed in 1991, there was a long delay until it was incorporated into the regular practice of western surgeons. In Brazil, there are only few case series reported and data on its safety and efficacy along with mid- and long-term results are desired. Present the mid-term results of laparoscopic gastrectomy with curative intent in the treatment of gastric adenocarcinoma and review the current evidence on the therapy of this neoplasia with the laparoscopic access. Patients who underwent D2 laparoscopic gastrectomy for gastric adenocarcinoma were retrospectively reviewed. Sixty-nine patients met the inclusion criteria. The mean age was 59.2 years and the mean body mass index was 24.2 kg/m2. Subtotal gastrectomy was performed in 73.9%. The mean number of harvested lymph nodes was 36.7, increased lymph node count and shorter operative time were observed in the last 34 cases. Median hospital stay was 8 days. Postoperative complications occurred in 22 (31.9%) cases. Surgical mortality was 4.3%. Laparoscopic gastrectomy can be performed safely with excellent short- and mid-term results. As experience increases, surgical duration is reduced and lymph node count rises.

Long-Term Outcomes in Laparoscopic D2 Gastrectomy for Gastric Cancer: a Large Comprehensive Study Proposing Novel Hypotheses

BackgroundThe long-term outcomes of laparoscopic gastrectomy (LG) versus open gastrectomy (OG) for gastric cancer (GC) remain obscure, especially for advanced cancer and disease affecting the upper stomach and in older patients. This study aimed to comprehensively assess the long-term efficacy of LG for GC using a large prospective database. MethodsTotally, 1877 consecutive patients (1186 receiving LG and 691 OG) operated in 2004–2016 were analyzed, with a median follow-up of 63 months. Association of LG versus OG with disease-specific survival (DSS) and disease-free survival (DFS) overall and in various subgroups were investigated using multivariable Cox regression. Propensity score matching (PSM) was performed for sensitivity analysis. ResultsBefore PSM, overall, there was no significant association of LG versus OG with survival after multivariable adjustment; however, in subgroup analyses, LG was associated with superior DSS in patients aged ≥ 70 years and those with upper GC. No significant associations regarding DFS were observed overall or in stratifications. PSM analyses revealed that LG was associated with better DSS also in patients aged ≥ 70 years (hazard ratio (HR) = 0.33, 95% confidence interval (CI) = 0.15–0.72) and in those with upper GC (HR = 0.51, 95% CI = 0.29–0.91), and with better DFS in those with upper GC (HR = 0.60, 95% CI = 0.37–0.99). Multivariable analysis showed that age, hepatitis B, performance status, tumor histology, stage, and vascular invasion were significantly associated with post-LG survival. LG-specific nomograms were then constructed with concordance indexes of 0.814 (DSS) and 0.809 (DFS) and excellent calibration. ConclusionsIn this large institutional analysis, while LG for GC was associated with DSS and DFS similar to those for OG overall, non-inferior LG-associated survival especially DSS was observed in some subgroups rarely investigated in prospective or randomized settings. There could still be biases even after PSM due to confounders not accounted for in this observational study. However, these findings offer novel hypotheses for further validation.

Long-term outcomes in laparoscopic D2 gastrectomy for gastric cancer: A large comprehensive study proposing novel hypotheses.

e16025Background: The long-term outcomes of LG versus open gastrectomy (OG) for GC remain obscure, especially for advanced cancer and disease affecting the upper stomach and in older patients. This...

Adjuvant therapy for locally advanced gastric cancer.

D2 gastrectomy is now the globally accepted surgical standard for locally advanced gastric cancer. However, since 2000, different evidence has emerged regarding the efficacy of adjuvant chemoradiation, perioperative adjuvant chemotherapy, and postoperative chemotherapy for locally advanced gastric cancer. This review summarizes the background, current status, and future perspectives of adjuvant therapy for locally advanced gastric cancer. The Intergroup 0116 study was the first to show the significant overall survival benefits of adjuvant (chemoradiation) therapy for gastric cancer. The second study was the MAGIC trial, which showed the efficacy of perioperative adjuvant chemotherapy. Although the findings from the Intergroup 0116 study and the MAGIC trial were positive, recent studies, such as the ARTIST and EORTC 40954 studies, found no survival benefit for patients who had undergone D2 gastrectomy for gastric cancer. Regarding the adjuvant chemotherapy strategy, two pivotal phase III trials: the ACTS-GC and the CLASSIC, demonstrated the efficacy of postoperative adjuvant chemotherapy following D2 gastrectomy. However, more intensive chemotherapy is necessary to improve the survival rate. Several studies have analyzed the effectiveness of molecular-targeted therapy against metastatic gastric or gastroesophageal junction carcinoma. Further studies should focus on the survival benefit of more-intensive adjuvant therapy with D2 resection, or with concurrent molecular-targeted therapy.

Subset of patients with unfavorable T1N2-3M0 gastric cancer for whom surgery alone is the standard treatment.

105 Background: ACTS-GC trial demonstrated that S-1 is effective as adjuvant chemotherapy for Japanese patients who have undergone curative D2 gastrectomy for gastric cancer and were diagnosed with pathological stage II disease. However, stages T1N2M0 and T1N3M0, which are classified as part of Stage II, were excluded from the ACTS-GC trial. The aim of the present study was to identify the unfavorable subset of patients with T1N2M0 and T1N3M0 gastric cancer for whom surgery alone is the standard treatment. Methods: The present study examined 59 patients who were diagnosed with T1N2M0 or T1N3M0 gastric cancer at Kanagawa Cancer Center and Yokohama City University Hospital between January 2000 and June 2010. Univariate and multivariate analyses were performed to identify risk factors for overall survival using a Cox proportional hazards model. Results: When overall survival was compared by the log-rank test, a significant difference was observed with regard to macroscopic tumor diameter. A macroscopic tumor diameter greater than 30mm was regarded as a critical point of classification considering the survival. Mulitivariate Cox’s proportional hazard analyses demonstrated that macroscopic tumor diameter was the only significant independent prognosticator. The five-year survival was 60.0% in patients with a macroscopic tumor diameter < 30mm, and 84.6% in those with a macroscopic tumor diameter > 30mm (P = 0.027). Conclusions: Among T1N2M0 and T1N3M0 gastric cancer patients for whom surgery alone is the standard treatment, having a small T1N2-3 tumor of less than 30 mm in diameter was the sole risk factor for gastric cancer survival. These tumors might be another target for adjuvant chemotherapy.

Neoadjuvant chemotherapy in controlling lymph node metastasis for locally advanced gastric cancer in a Chinese population

This study aimed to evaluate the efficacy of FOLFOX6, SOX and XELOX as neoadjuvant chemotherapy for advanced gastric cancer. The study retrospectively assessed clinicopathological data of patients who received a radical D2 gastrectomy for gastric cancer from January 2010 to January 2013.The patients were either not administered neoadjuvant chemotherapy (control) or were given FOLFOX6, SOX and XELOX prior to surgery. The metastatic rate was also higher for the control group compared with the three chemotherapy regimens in N2 station lymph nodes (P < 0.001). The SOX group had significantly lower metastatic total and N2 station lymph nodes than FOLFOX6 and XELOX (P < 0.01). The frequency of metastatic lymph nodes relative to total lymph nodes examined was 9.9, 6.6, 3.9 and 5.3% for control, FOLFOX6, SOX and XELOX groups, respectively. In conclusion, SOX may be the most effective of these treatments as preoperative chemotherapy for Chinese patients with advanced gastric cancer.

Surgical care quality and oncologic outcome after D2 gastrectomy for gastric cancer.

To examine the quality of surgical care and long-term oncologic outcome after D2 gastrectomy for gastric cancer. From 1999 to 2008, a total of 109 consecutive patients underwent D2 gastrectomy without routine pancreaticosplenectomy in a multimodal setting at our institution. Oncologic outcomes together with clinical and histopathologic data were analyzed in relation to the type of surgery performed. Staging was carried out according to the Union for International Cancer Control criteria of 2002. Patients were followed-up for five years at the outpatient clinic. The primary measure of outcome was long-term survival with the quality of surgery as a secondary outcome measure. Clinical data were retrospectively collected from the patient records, and causes of death were obtained from national registries. A total of 109 patients (58 men) with a mean age of 67.4 ± 11.2 years underwent total gastrectomy or gastric resection with D2 lymph node dissection. The tumor stage distribution was as follows: stage I, (27/109) 24.8%; stage II, (31/109) 28.4%; stage III, (41/109) 37.6%; and stage IV, (10/109) 9.2%. Forty patients (36.7%) received chemotherapy or chemoradiotherapy. The five-year overall survival rate for all 109 patients was 45.0%, and was 47.1% for the 104 patients treated with curative R0 resection. The five-year disease-specific survival rates were 53.0% and 55.8%, respectively. In a multivariate analysis, body mass index and tumor stage were independent prognostic factors for overall survival (both P < 0.01), whereas body mass index, tumor stage, tumor site, Lauren classification, and lymph node invasion were prognostic factors for cancer-specific survival (all P < 0.05). Postoperative 30-d mortality was 1.8% and 30-d, surgical (including three anastomotic leaks, two of which were treated conservatively), and general morbidities were 26.6%, 12.8%, and 14.7%, respectively. D2 dissection is a safe surgical option for gastric cancer, providing quality surgical care and long-term oncologic outcomes that are in line with current Western standards.

Randomized clinical trial comparing survival after D1 or D2 gastrectomy for gastric cancer (Br J Surg 2014; 101: 23–31)

Randomized clinical trial comparing survival after D1 or D2 gastrectomy for gastric cancer (<i>Br J Surg</i> 2014; 101: 23–31)

Randomized clinical trial comparing survival after D1 or D2 gastrectomy for gastric cancer

It is still unclear whether D2 lymphadenectomy improves the survival of patients with gastric cancer and should therefore be performed routinely or selectively. The aim of this multicentre randomized trial was to compare D2 and D1 lymphadenectomy in the treatment of gastric cancer. Between June 1998 and December 2006, patients with gastric adenocarcinoma were assigned randomly to either D1 or D2 gastrectomy. Intraoperative randomization was implemented centrally by telephone. Primary outcome was overall survival; secondary endpoints were disease-specific survival, morbidity and postoperative mortality. A total of 267 eligible patients were allocated to either D1 (133 patients) or D2 (134) resection. Morbidity (12.0 versus 17.9 per cent respectively; P = 0.183) and operative mortality (3.0 versus 2.2 per cent; P = 0.725) rates did not differ significantly between the groups. Median follow-up was 8.8 (range 4.5-13.1) years for surviving patients and 2.4 (0.2-11.9) years for those who died, and was not different in the two treatment arms. There was no difference in the overall 5-year survival rate (66.5 versus 64.2 per cent for D1 and D2 lymphadenectomy respectively; P = 0.695). Subgroup analyses showed a 5-year disease-specific survival benefit for patients with pathological tumour (pT) 1 disease in the D1 group (98 per cent versus 83 per cent for the D2 group; P = 0.015), and for patients with pT2-4 status and positive lymph nodes in the D2 group (59 per cent versus 38 per cent for the D1 group; P = 0.055). No difference was found in overall 5-year survival between D1 and D2 resection. Subgroup analyses suggest that D2 lymphadenectomy may be a better choice in patients with advanced disease and lymph node metastases. ISRCTN11154654 (http://www.controlled-trials.com).

Is There Any Role of Additional Retropancreatic Lymph Node Dissection on D2 Gastrectomy for Advanced Gastric Cancer?

Extended lymph node dissection beyond D2 in resectable gastric cancer has not shown any survival benefits. However, whether the retropancreatic (No. 13) lymph node should be dissected still remains controversial. The purpose of this study was to evaluate the effects of additional No. 13 lymph node dissection on D2 gastrectomy for gastric cancer in terms of overall survival. From May 2001 to December 2006, 528 patients underwent curative resection for the middle- or lower-third advanced gastric cancer at the National Cancer Center, Korea. The patients were grouped according to whether a No. 13 lymphadenectomy was performed (13D+/13D-). Clinicopathological characteristics and treatment-related factors were compared between the two groups. The overall survival was analyzed using the Cox proportional hazard model. The incidence of No. 13 lymph node metastasis was 6.7%. There was no significant difference in morbidity or mortality between the 13D+ and 13D- groups. In clinical stages I/II, No. 13 lymph node dissection did not affect overall survival. However, it was an independent prognostic factor in patients with clinical stages III/IV gastric cancer (hazard ratio (HR), 0.55; P=0.022). Additional retropancreatic lymph node dissection beyond a D2 gastrectomy might be favorable for survival in patients with clinical stage III/IV middle- or lower-third gastric cancer.

Nomogram Predicting Long-Term Survival After D2 Gastrectomy for Gastric Cancer

The aim of this study was to combine clinicopathologic variables associated with overall survival after gastric resection with D2 lymphadenectomy (D2 gastrectomy) for gastric cancer into a prediction nomogram. We retrospectively analyzed 7,954 patients who underwent D2 gastrectomy for gastric cancer at Seoul National University Hospital (SNUH) in Seoul, Korea. Two thirds of the patients were randomly assigned to the training set (n = 5,300), and one third were assigned to the validation set (n = 2,654). Multivariate analysis by Cox proportional hazards regression was performed using the training set, and the nomogram was constructed. Discrimination and calibration were performed using the SNUH validation set. Additional external validation was performed using the data set (n = 2,500) from Cancer Institute Ariake Hospital (CIAH) in Tokyo, Japan. The multivariate Cox model identified age at diagnosis, sex, location, depth of invasion, number of metastatic lymph nodes, and number of examined lymph nodes as covariates associated with survival. In the SNUH validation set, the nomogram exhibited superior discrimination power compared with the seventh American Joint Committee on Cancer TNM classification (Harrell's C-index, 0.78 v 0.69, respectively; P < .001). Calibration of the nomogram predicted survival corresponding closely with the actual survival. In the CIAH validation set, discrimination was good (C-index, 0.79), and the predicted survival was within a 10% margin of ideal nomogram. We developed a nomogram predicting 5- and 10-year overall survival after D2 gastrectomy for gastric cancer. Validation using the SNUH and CIAH data sets revealed good discrimination and calibration, suggesting good clinical utility. The nomogram improved individualized predictions of survival.

Resultados da gastrectomia D2 para o câncer gástrico: dissecção da cadeia linfática ou ressecção linfonodal múltipla?

Eastern literature is remarkable for presenting survival rates for surgical treatment of gastric adenocarcinoma superior to those presented in western countries. To analyze the long-term result after D2 gastrectomy for gastric cancer. Two hundred seventy four underwent gastrectomy with D2 lymph node dissection as exclusive treatment. The inclusion criteria were: 1) lymph node removal according to Japanese standardized lymphatic chain dissection; 2) potentially curative surgery described in medical records as D2 or more lymph node dissection; 3) tumoral invasiveness of gastric wall restricted to the organ (T1-T3); 4) absence of distant metastasis (N0-N2/M0); 5) a minimum of five years follow-up. Clinical pathological data included sex, age, tumor location, Borrmann's macroscopic tumor classification, type of gastrectomy, mortality rates, hystological type, TNM classification and staging according to UICC TNM 1997. Total gastrectomy was performed in 77 cases (28.1%) and subtotal gastrectomy in 197 (71.9%). The tumor was located in the upper third in 28 cases (10.2%), in the middle third in 53 (19.3%), and in the lower third in 182 (66.5%). Among patients that had their Borrmann's classification assigned, five cases (1.8%) were BI, 34 (12.4%) BII, 230 (84.0%) BIII and 16 (5.9%) BIV. Tumors were histologically classified as Laurén intestinal type in 119 cases (43.4%) and as diffuse type in 155 (56.6%). According to UICC TNM 1997 classification, early gastric cancer (T1) was diagnosed in 68 cases (24.8 %); 51 (18.6%) were T2, and 155 (56.6%) were T3. No lymph node involvement (N0) was observed in 129 cases (47.1%), whereas 100 (36.5%) were N1 (1-6 lymph nodes), and 45 (16.4%) were N2 (7-15 lymph nodes).The median number of lymph nodes dissected was 35. The overall long-term (five-year) survival rate, for stages I to IIIb was 70.4%. Digestive surgeons must be stimulated in performing D2 gastrectomies to avoid wasting the only treatment to gastric adenocarcinoma that has proven to be efficient up to this days. It must be emphasized that standardized lymph nodes dissection according to tumor location is more important that only the number of removed nodes.

Expanding laparoscopic gastrectomy for gastric cancer outside Korea and Japan

During the past four decades, open gastrectomy with D2 lymphadenectomy has been the standard approach for resectable gastric cancer in Japan. But only recently with evidence from western phase 3 randomized controlled trials for the safety and survival benefit of D2 versus D1 surgery [1], D2 surgery can be recommended for wide practical implementation when it results in a complete tumor resection (R0). During the past decade, large retrospective studies and small randomized trials, mostly from Korea and Japan, have reported positive results with laparoscopic surgery mainly for early gastric cancer [2]. However, totally laparoscopic D2 gastrectomy particularly for advanced gastric cancer, is a highly demanded, timeconsuming procedure that requires evaluation in clinical trials for its safety and efficacy considering also cost-benefit analysis compared with standard open D2 surgery [3]. The recent report for laparoscopic D2 gastrectomy for gastric cancer by Moisan and colleagues [4] in the March issue of Surgical Endoscopy comes not from Korea, Japan, or specialized hospitals in the United States or European Union but from Chile. In this country, along with Asia and east European countries, incidence of gastric cancer continues to be high, which may explain advances with laparoscopic surgical treatment. Moisan and colleagues [4] compared early and longterm outcomes of 31 gastric cancer patients who underwent totally laparoscopic D2 gastrectomy (LG) with intracorporeal handsewn esophagojejunostomy between 2003 and 2010 with those of 31 patients who received an open D2 gastrectomy (OG) as the standard group. There were major complications with two vs. no duodenal stump leakages in LG and OG respectively and two esophagojejunostomy anastomotic leakages in each group. After a median followup of 3 years, there was no significant difference in recurrence-free survival or overall survival between the two groups. The authors conclude that laparoscopic D2 surgery is feasible, safe, and as effective as open D2 surgery regarding oncological outcomes. This study provides many positive aspects. Totally laparoscopic gastrectomy with total gastrectomy and D2 lymphadenectomy is a highly demanding procedure that is feasible, safe, and effective with respect to long-term survival only when it is performed by high-volume surgeons with expertise and skill in this technique. The 35 retrieved lymph nodes in the laparoscopic group reveals the standardized and completeness of D2 lymphadenectomy that is essential for locoregional tumor control in advanced lymph node-positive disease. However, some questions raise the relatively high rates of leakages in duodenal stump and esophagojejunostomy. Laparoscopic surgery has evolved rapidly and provides evidence for its superiority for the treatment of colon cancer and positive data for rectal cancer treatment [5–7]. However, at present, totally laparoscopic D2 gastrectomy for advanced potentially curable gastric cancer, despite sporadic reports with enhanced results, requires evaluation within clinical trials and cannot be recommended outside highly specialized hospitals [3]. Although laparoscopic surgery can improve quality of life [8–11], the grand challenge remains of how the cancer genome heterogeneity and complexity of cancer cells in individual patient’s tumors can be overcome. Recently, the addition of trastuzumab to chemotherapy in HER2-positive metastatic or advanced gastric cancer has become the new standard, and new phase 3 trials also may establish its use C. Hottenrott (&) Chirurgische Klinik, St. Elisabethenkrankenhaus, Ginnheimer Strase 3, 60487 Frankfurt, Germany e-mail: info@gastricbreastcancer.com

P-0019 Propotion of Early Gastric Cancer is Indirectly Correlated with Survival after Radical Surgery for Gastric Cancer at any Resectable Stage

ABSTRACT Introduction Geographic variability in prognosis of gastric cancer (GC) is well documented, as in Japan series higher survival rates were reported when compared with Western patients at the same stage of disease. We suppose any resectable stage (I-III stages) of GC can be subdivided into two subcategories – without and with synchronous occult distant metastases (SOcDM). Unfortunately today we are unable to establish the existence of SOcDM. That is why we categorize both subcategories in one stage, but really they are distinct “stages”. We postulate that higher proportion of early gastric cancer (EGC) in a large cohort of patients is correlated with lower percentage of SOcDM in cases of resectable GC. Methods We investigated our own data and papers written by authors of Japan and Western Europe studying EGC, survival after D2 gastrectomy for GC, and analyzing the frequency of synchronous obvious distant metastases (SObDM) published in English from 1992 to 2011 which were available to us and were not purposefully chosen. We calculated the frequency of SOcDM by the formula Foc= kFob, where Foc is the frequency of SOcDM, Fob is the frequency of SObDM, k is constant. Arithmetically we found k constant to be roughly 2. Results We determined that in Japan: 1) the proportion of EGC among all GC cases is higher (mean, 48% versus 17%, P Conclusion This is a new phenomenon being one of the independent powerful factors that impose on survival of patients with resectable GC. Difference in survival rates after RS for GC between Japan and Western Europe is to a great extent related to this phenomenon.

Prognostic Factors in Patients with Node-Negative Gastric Cancer: A Single Center Experience from China

Background and ObjectivesLymph node metastasis was the most important prognostic factor in gastric cancer. Patients with node-negative gastric cancer presented better survival. However, some of them would die of the disease. The aim of this study was to evaluate the prognostic factors of patients with node-negative gastric cancer. MethodsFrom 1996 to 2007, 4,426 patients had undergone curative D2 gastrectomy for gastric cancer at the Fudan University Shanghai Cancer Center. Patients with node-negative gastric cancer who underwent curative D2 gastrectomy with more than 15 lymph nodes dissected were selected into this study. The prognostic value of pathological features was investigated. ResultsThis study included 234 patients with node-negative gastric cancer. The 5-year overall survival in these patients was 85 %. The factors correlating significantly with overall survival on univariate analysis included age (P = 0.016), depth of invasion (P = 0.000), tumor size (P = 0.013), tumor site (P = 0.000), histological grade (P = 0.009), lymphatic tumor emboli (P = 0.014), vascular tumor emboli (P = 0.005), and nervous invasion (P = 0.033). Multivariate analysis showed that lymphatic tumor emboli (hazard ratio (HR) = 7.270), vascular tumor emboli (HR = 3.010), and depth of invasion (HR = 2.735) were defined as independent prognostic factors. ConclusionAmong patients with node-negative gastric cancer and higher risk for recurrence, the use of adjuvant therapies should be considered.

Adjuvant chemotherapy after D2 gastrectomy for gastric cancer

In the CLASSIC study, capecitabine–oxaliplatin was an effective chemotherapy after D2 gastrectomy for stage II–IIIB gastric cancer. We compared these data with the ACTS-GC study, which was the only pivotal study proving the benefit of adjuvant chemotherapy in these patients. Long-term survival data from CLASSIC are awaited with interest.boxed-text

Body weight loss after surgery as an independent risk factor for continuation of S-1 adjuvant chemotherapy for gastric cancer.

125 Background: S-1 adjuvant chemotherapy improves survival of stage II/III gastric cancer, however, the compliance is not high. The aim of the present study is to clarify risk factors for continuation of S-1 after gastrectomy. Methods: Patients were retrospectively selected according to the following criteria; (1) patients underwent curative D2 gastrectomy for gastric cancer during 2002 and 2010, (2) pathological stage II/III, (3) creatinine clearance more than 60 ml/min, and (4) S-1 was initiated at a dose of 80mg/m2 within 6 weeks after surgery. Clinical factors when starting S-1 chemotherapy were examined by uni- and multi-variate analyses. Results: Seventy-five patients were eligible. Median age was 62 years (range: 36-80). Performance status was 0 in 65 patients and 1 in 10. Serum albumin level was &gt;4.0 g/dl in 34 patients and &lt;4.0 g/dl in 39. Operative procedure was total gastrectomy (TG) in 46 patients and distal one in 29. Median percentile of body weight loss to preoperative state (%BW loss) was 9.3 (range 0-21.1). Stage was II in 22 patients and III in 53. When %BW loss was classified to two groups; LOW (&lt;15%, n=64) and HIGH (&gt;15%, n=11), S-1 continuation rates were 82.8% in the LOW and 54.6% in the HIGH at 3 months and 73.2% in the LOW and 45.5% in the HIGH at 6 months, which were statistically significant (p=0.025). Among age, performance status, type of gastrectomy, %BW loss, serum albumin, and stage, only %BW loss was a significant independent risk factor for S-1continuation with hazard ratio of 2.437 by multi-variate Cox proportional hazard analyses (p=0.039). Conclusions: To improve drug compliance which leads to survival, it is a key to maintain BW before starting adjuvant chemotherapy. Peri-operative nutritional therapy should be developed and be focused on chronic inflammatory phase after surgery and on starvation after gastrectomy. A randomized phase III trial is on-going to show efficacy of peri-operative nutritional support including eicosapentaenoic acid (EPA).