A Taiwanese surgeon yesterday suggested that more comprehensive surgical procedures increased the long-term survival chances of advanced gastric cancer sufferers.
Gastric cancer is the second most prevalent cancer and the fifth most common cause of cancer-related deaths in the world, said Wu Chew-wun (吳秋文), convenor of the Taipei Veterans General Hospital's division of general surgery, at the 11th Annual Meeting of the Taiwan Cooperative Oncology Group in Taipei.
The meeting brought together experts in researching and treating gastric, hepato-biliary and pancreatic cancer from Taiwan, the US, the UK, France, Japan and Korea.
Wu presented the results of an ongoing study he began in 1993, saying that surgeons could boost the survival rates and the quality of life after surgery of gastric cancer patients by removing more lymph nodes than is normally done.
"Our findings received wide international attention; in particular, Japanese medical professionals in the [gastric] field are contemplating revising their current surgical guidelines according to our study," Wu said.
In the initial stages, gastric cancer is virtually painless, making early detection difficult, he said, adding that "by the time patients are diagnosed with gastric cancer, they almost always require surgery."
But the extent of lymph node removal has been a constant subject of debate, Wu said.
While "standard" treatment involves "the removal of the perigastric lymph nodes directly attached to the resected stomach, an alternative is to additionally remove lymph nodes around the primary tumor, such as those in the blood vessels supplying the stomach, hepatoduodenal ligament, retropancreatic region and the superior mesenteric vein," he told the conference.
To test the relative advantages of the two and improve gastric cancer prognosis, Wu's team launched their research project examining the results of the different procedures.
He said the study was the first of its kind.
The study randomly assigned 221 patients between 1993 and 1999 to either the traditional or more extensive procedure. None of the patients received post-surgery radiotherapy or chemotherapy, he said.
The team has since closely monitored the condition of both groups, including survival rates and quality of life, he said, adding that several noteworthy findings had emerged.
In particular, although the group that received more extensive surgery had a higher rate of short-term death, more complications and longer hospital stays compared with the other group, their five-year survival rate was higher [59.5 percent versus 53.6 percent], Wu said, calling the difference statistically significant.
Wu cautioned that further research needed to be done before surgeons could feel confident about the results.
More extensive "surgeries should be done on patients who are relatively physically strong, by experienced surgeons who are well-trained in the procedure and who work at medical institutions that frequently perform such surgeries," he said.
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