The rationale for early postoperative intraperitoneal chemotherapy for gastric cancer

Abstract

Gastric cancer is still a major source of morbidity and mortality worldwide [1], despite the falling incidence in many countries [2–4]. The average patient presenting with a primary gastric malignancy in Europe or the United States undergoing surgery will face a mortality rate of 10% or more, with fewer than 20% surviving 5 years [5]. In a large European study of over 13,000 patients [6], the 5- and 10-year survival was 5.5% and 3.8%, respectively, with 73% of patients not undergoing resection. An update of this study demonstrated that over a 25-year period, the incidence fell from 17.4/100,000 to 15.3/ 100,000, with 79% of patients having stage IV disease and with only 1 % having stage I disease; curative resection was undertaken in only 21 %, and the resulting mortality rate for partial and total gastrectomy was 13% and 29%, respectively; the 5-year survival rate was 5% overall [7]. In Japan, in contrast to these dismal results, a reduction in the operative mortality rate and a corresponding increase in the 5-year survival rate has been achieved [8]. This may well be as a result of the cooperation between endoscopists, surgeons, and pathologists [9], which will be discussed later. Both adjuvant radiotherapy and chemotherapy have been used in order to prolong survival, although so for without success [1], and this topic is fully discussed elsewhere in the book.