[Surgery and adjuvant therapy of gastric cancer]

A remarkable improvement of prognosis has been obtained in surgery for patients with gastric cancer in Japan. This is attributed to the standardization of prophylactic lymphadenectomy and the prescription of adjuvant anticancer chemotherapy. Postoperative long-term cancer chemotherapy (PLCC), available from 1970, using MMC, Tegafur and PSK in addition to curative surgery has prolonged the survival time of patients with serosal and/or secondary lymphatic metastasis. To confirm the efficacy of adjuvant chemotherapy on a wide basis, the Cooperative Study Group of Surgical Adjuvant Chemotherapy for Gastric Cancer was organized in 1975. The first and the second study revealed that postoperative bolus injection of MMC and long-term administration of Tegafur improved the survival rate of patients with stage III and lymphatic with serosal metastasis. The third pilot study showed that immunotherapy using PSK and/or OK-432 with anticancer drugs might be effective for gastric cancer. To promote extensive investigations of a large number of patients, the Japanese Foundation for Multidisciplinary Treatment of Cancer was founded in 1980, and the first study suggested that immunochemotherapy using MMC, Tegafur, PSK and OK-432 is effective for gastric cancer. Efficacy of MMC and Tegafur treatment was obtained in some types, such as female cases, those with undifferentiated adenocarcinoma of Borrmann types II and IV and those given curative resection. It is therefore necessary to seek a proper regimen for each type of patient for the concept of Type-oriented Therapy (TOT).