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(endoscope biopsy)
(EUS, endoscopic ultrasonography)
(abdomen CT) X-
D2 extensive(tailored
approach)
TNM( AJCC 7th edition)
(EGC, early gastric cancer) (mucosa)
(submucosa) (AGC, Advanced gastric cancer)(muscularis propia)
( )
1
2(cT1a, mucosa)2
(differentiation)(lymphovascular invasion)
(margin)
(EMR,
2015 59 7 43
Endoscopic Mucosal Resection)(ESD, Endoscopic Submucosal
Dissection) EMR2
ESD
(IT-knife)ESD 2
(en-bloc resection)
(Radical Gastrectomy)
D2 (D2 dissection)2,3
(Extensive dissection) D2 D2
dissection 2006 (D3)
D1 5 (59.5% vs 53.6%, P=0.04)
4 1990 (British and Dutch trial)D2 dissection
D 22010
Dutch trial Lancet Oncology 15D2 dissection
5
(IGCSG) 2010D2 dissection
D16 D2
(Advanced gastric cancer)(Para-aortic Lymph
Node Dissection, PAND)PAND
5 20% 2000
PAND 90PAND (JCOG9501)
2008 NEJM7 PAND
8%PAND
WhippleAppleby
(R0)
5 90%90(function preserving
2015 59 7 44
gastrectomy) (limited gastrectomy) D1+
( D2 )8
Kitano9 1994B1 (less invasive
surgery)D2
Phase 2 (JACOG 0703)
10
Phase 3 study JCOG 0912KLASS
11,12
(Adjuvant Chemotherapy)
D 2
TS-1( ®)
ACTS-GC phase IIID2 TS-1
10% 5 12.3% 5II-III
TS-1 13,14
phase 3 CLASSIC CapecitabineOxaliplatin (XELOX) 3
14%15
5-FU D2
MAGIC trial
16
(Neoadjuvant)
(tumor down staging)TS-1 Cisplatin
87.8% 348%17
fluoropyrimidine(5-FU) platinum
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( ) HER2fluoropyrimidine platinum
t r a s t u z u m a b (Herceptin® ) phase 3 ToGA 18 trastuzumab
(13.8 vs. 11.1 months; HR 0.74; p=0.0046)
phase 3 anti-VEGF antibody, anti-EGFR antibody, mTOR inhibitor
(chemoradiation)D1 McDonald (Int 0116)
D2
(Polysaccharide)
(Polysaccharide K, Krestin®)19,20
(Multimodality therapy)
1. --. 2013; 24:
19-28.
2. : J apanese gas t r i c cancer treatment guidelines 2010 (ver.3). Gastric Cancer: online 14 May 2011.
3. Saka M, Morita S, Fukagawa T: Present and Future Status of Gastric Cancer Surgery. Jpn J Clin Oncol 2011; 41(3): 307-13.
4. Wu CW, Hsiung CA, Lo SS: Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol 2006; 7: 309-15.
5. Songun I, Putter H, Kranenbarg EM: Surgical
2015 59 7 46
treatment of gastric cancer: 15-year follow-up results of the randomized nationwide Dutch D1D2 trial. Lancet Oncol 2010; 11: 439-49.
6. Degiuli M, Sasako M, Ponti A: Morbidity and mortality in the Italian Gastric Cancer Study Group randomized clinical trial of D1 versus D2 resection for gastric cancer. Br J Surg 2010; 97: 643-9.
7. S a s a k o M , S a n o T, Ya m a m o t o S : D 2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med 2008; 359: 453-62
8. Tsujitani S, Oka S, Saito H: Less invasive surgery for early gastric cancer based on the low probability of lymph node metastasis. Surgery 1999; 125: 148-54.
9. Kitano S, Iso Y, Moriyama M: Laparoscopic-assisted Billroth I gastrectomy. Surg Laparosc Endosc 1994; 4: 146-8
10. Katai H, Sasako M, Fukuda H, et al: Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 2010; 13: 238-44.
11. Nakamura K, Katai H, Mizusawa J, et al: th Nodal Dissection for Clinical Stage IA/IB Gastric Cancer (JCOG0912). Jpn J Clin Oncol 2013; 43: 324-7.
12. K i m H H , H y u n g W J , C h o G S , e t a l : Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 2010; 251: 417-20.
13. Sakuramoto S, Sasako M, Yamaguchi T, et al: Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 2007; 357: 1810–20.
14. Sasako M, Sakuramoto S, Katai H, et al: Five-Year Outcomes of a Randomized Phase III Trial Comparing Adjuvant Chemotherapy With S-1 Versus Surgery Alone in Stage II or III Gastric Cancer. J Clin Oncol 2011; 29: 4387–93
15. Bang YJ, Kim YW, Yang HK, et al: Adjuvant capecitabine and oxaliplatin for gastric cancer: results of the phase III CLASSIC trial. 2011 ASCO Annual Meeting. J Clin Oncol 2011; 29: LBA4002.
16. Cunningham D, Allum WH, Stenning SP, et al: Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006; 355: 11-20.
17. Kochi M, Fujii M, Kanamori N, et al: Phase II Study of Neoadjuvant Chemotherapy With S-1 and CDDP in Patients With Lymph Node Metastatic Stage II or III Gastric Cancer. Am
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J Clin Oncol 2014 Mar 21. [Epub ahead of print]
18. Bang YJ, Cutsem EV, Andrea F, et al: for t rea tment of HER2-pos i t ive advanced gastr ic or gastro-oesophageal junct ion cancer (ToGA): a phase 3, open-label , randomised controlled trial. The Lancet 2010; 376(9742): 687-97.
19. Hiroaki N, Akihiko K, Shigetoyo S, et al: Efficacy of Immunochemotherapy as Adjuvant Treatment after Curative Resection of Gastric Cancer. Lancet 1994; 343: 1122-6.
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