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Article: Gastric cancer in Asia: Progress and controversies in surgical management

TitleGastric cancer in Asia: Progress and controversies in surgical management
Authors
Issue Date1998
PublisherBlackwell Publishing Asia. The Journal's web site is located at http://www.blackwellpublishing.com/journals/ANS
Citation
Australian And New Zealand Journal Of Surgery, 1998, v. 68 n. 3, p. 172-179 How to Cite?
AbstractConsiderable controversy surrounds the management of gastric cancer and this has largely overshadowed recent progress in our under- standing of the epidemiology and molecular pathogenesis of the disease, and improvements in diagnostic and staging techniques. Differences identifiable in the molecular pathogenesis of the 'intestinal' and 'diffuse' types of gastric cancer may help to untravel the biological behaviour of variants and ultimately influence therapeutic strategies. Endoscopic ultrasound is well established as being accurate for T staging and the introduction of laparoscopy, with or without ultrasound, is obviating unnecessary laparotomy in non bleeding, non-obstructed patients. Controversies in surgery encompass the role of laparoscopic surgery in early gastric cancer, the extent of lymphadenectomy including para-aortic nodal dissection, resection of en bloc contiguous organ involvement, pancreatosplenectomy, left upper abdominal evisceration, and modes of reconstruction (pylorus-preserving gastrectomy, pouch formation) to enhance quality of life. Whereas adjuvant chemotherapy does not impact favourably on survival, emphasis has now shifted to neoadjuvant (induction) chemotherapy to downstage the disease. Preoperative regional chemotherapy and intra-operative hyperthermic chemotherapy or irradiation may prove to be of benefit in patients with resectable disease, but some scepticism still exists as to the usefulness of biological response modifiers (e.g. OK432, PSK) for adjuvant treatment. Ethical issues relating to cultural differences in Asia sometimes mitigate against adequate trial design (e.g, a surgery-alone control group or a no adjuvant therapy treatment group may be considered inappropriate) and this has understandably hindered acceptance in Western countries of the value of current management practices in Asia. These issues and the need for ongoing well- conducted randomized trials with prospective subset analysis are now being addressed.
Persistent Identifierhttp://hdl.handle.net/10722/84418
ISSN
2003 Impact Factor: 0.874
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorBranicki, FJen_HK
dc.contributor.authorChu, KMen_HK
dc.date.accessioned2010-09-06T08:52:44Z-
dc.date.available2010-09-06T08:52:44Z-
dc.date.issued1998en_HK
dc.identifier.citationAustralian And New Zealand Journal Of Surgery, 1998, v. 68 n. 3, p. 172-179en_HK
dc.identifier.issn0004-8682en_HK
dc.identifier.urihttp://hdl.handle.net/10722/84418-
dc.description.abstractConsiderable controversy surrounds the management of gastric cancer and this has largely overshadowed recent progress in our under- standing of the epidemiology and molecular pathogenesis of the disease, and improvements in diagnostic and staging techniques. Differences identifiable in the molecular pathogenesis of the 'intestinal' and 'diffuse' types of gastric cancer may help to untravel the biological behaviour of variants and ultimately influence therapeutic strategies. Endoscopic ultrasound is well established as being accurate for T staging and the introduction of laparoscopy, with or without ultrasound, is obviating unnecessary laparotomy in non bleeding, non-obstructed patients. Controversies in surgery encompass the role of laparoscopic surgery in early gastric cancer, the extent of lymphadenectomy including para-aortic nodal dissection, resection of en bloc contiguous organ involvement, pancreatosplenectomy, left upper abdominal evisceration, and modes of reconstruction (pylorus-preserving gastrectomy, pouch formation) to enhance quality of life. Whereas adjuvant chemotherapy does not impact favourably on survival, emphasis has now shifted to neoadjuvant (induction) chemotherapy to downstage the disease. Preoperative regional chemotherapy and intra-operative hyperthermic chemotherapy or irradiation may prove to be of benefit in patients with resectable disease, but some scepticism still exists as to the usefulness of biological response modifiers (e.g. OK432, PSK) for adjuvant treatment. Ethical issues relating to cultural differences in Asia sometimes mitigate against adequate trial design (e.g, a surgery-alone control group or a no adjuvant therapy treatment group may be considered inappropriate) and this has understandably hindered acceptance in Western countries of the value of current management practices in Asia. These issues and the need for ongoing well- conducted randomized trials with prospective subset analysis are now being addressed.en_HK
dc.languageengen_HK
dc.publisherBlackwell Publishing Asia. The Journal's web site is located at http://www.blackwellpublishing.com/journals/ANSen_HK
dc.relation.ispartofAustralian and New Zealand Journal of Surgeryen_HK
dc.titleGastric cancer in Asia: Progress and controversies in surgical managementen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0004-8682&volume=68&spage=172&epage=179&date=1998&atitle=Gastric+cancer+in+Asia:+progress+and+controversies+in+surgical+managementen_HK
dc.identifier.emailChu, KM: chukm@hkucc.hku.hken_HK
dc.identifier.authorityChu, KM=rp00435en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1111/j.1445-2197.1998.tb04739.x-
dc.identifier.pmid9563443-
dc.identifier.scopuseid_2-s2.0-0031947985en_HK
dc.identifier.hkuros33036en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0031947985&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume68en_HK
dc.identifier.issue3en_HK
dc.identifier.spage172en_HK
dc.identifier.epage179en_HK
dc.identifier.isiWOS:000072759000002-
dc.publisher.placeAustraliaen_HK
dc.identifier.scopusauthoridBranicki, FJ=7003617514en_HK
dc.identifier.scopusauthoridChu, KM=7402453538en_HK

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