Current status and prospect of perioperative therapy for locally advanced gastric cancer / 中华胃肠外科杂志

Local advanced gastric cancer (LAGC) accounts for a large proportion of annual newly diagnosed gastric cancer patients in China. There is a general consensus for D2 radical gastrectomy followed by postoperative adjuvant chemotherapy for LAGC patients, and this therapeutic strategy has been confirmed by a series of clinical trials to obviously improve the patients' prognosis; however, the recurrence rate is still high (about 50%-80% in advanced stage), which makes it difficult to further improve the long-term survival. Perioperative therapy, especially whether preoperative neoadjuvant therapy (NAT) can improve the efficacy of patients with LAGC, has been paid more and more attention. NAT is mainly defined as a preoperative chemotherapy or chemoradiotherapy, aiming at increasing curative resection rate by downstaging tumor, eliminating micrometastases, and autologously testing of anti-cancer drug sensitivity etc. However, there are still some controversy whether LAGC patients could gain survival benefit from NAT and also lack of general consensus for this issue. In this paper, the author reviews and analyzes the current situation of perioperative therapies for LAGC patients, especially emphasize the results of neoadjuvant chemotherapy or chemoradiotherapy reported by various high-level clinical studies. The preliminary effect of perioperative chemotherapy combined with molecular targeted or immunotherapy has also aroused great interest and attention. While we continue to carry out NAT and look forward to more new high-level evidence trials on NAT, we must emphasize again that R0 gastrectomy remains the most important therapeutic modality for the patients with LAGC.

Disputes and exploration of neoadjuvant and adjuvant therapy for colon cancer / 中华胃肠外科杂志

Perioperative treatment combined with radical resection is the major approach to cure non-metastatic colon cancer. A precise evaluation and perioperative treatment would probably improve the R0 resection rate, recurrence-free survival and overall survival of colon cancer patients. Recently, individualized treatment is the mainstream due to the development of molecular pathology and multi-disciplinary therapy. The indications and course of perioperative treatment and preoperative neoadjuvant therapy of colon cancer are still in intense discussion. The present review will mainly discuss three topics. Firstly, the various reaction of adjuvant therapy to stage II colon cancer is caused by patients′ heterogeneity. Choosing stratified treatment for these patients according to clinical and molecular pathological features is the future. Secondly, we discuss the adjuvant chemotherapy course for stage III colon cancer according to the Chinese Society of Clinical Oncology (CSCO) guideline and the progress of this field. Lastly, we summarize the status and significance of colon cancer neoadjuvant therapy.

Application of perioperative chemotherapy in locally advanced colorectal cancer / 中华胃肠外科杂志

Perioperative chemotherapy is the major component of therapeutic approaches in multidisciplinary team (MDT) of colorectal cancer. In resectable colorectal cancer, the role of systemic chemotherapy is more important. In resectable colon cancer, especially locally advanced high-risk T3 or T4 tumor, perioperative chemotherapy can confer downstaging of primary tumor, improve pathologic complete response (pCR) rate and postoperative tumor regression. However, long-term oncological outcomes need prolonging follow-up period and phase III randomized controlled trials to confirm. On the basis of standard of care with chemoradiation followed by surgery, total neoadjuvant threapy (TNT) strategy is suggested in locally advanced rectal cancer. Addition of systemic chemotherapy before or after chemoradiation showed advantages of more completion of neoadjuvant chemotherapy, high percentage of delivering drugs dosage, good compliance and tolerance. The trend toward higher pCR rate was also observed in TNT strategy. Neoadjuvant chemotherapy without chemoradiation had similar long-term efficacies compared with concurrent chemoradiation, with avoiding functional impairment and secondary cancers. In brief, perioperative chemotherapy plays a very important role in MDT of colorectal cancer.

Comparison of International Guidelines on the Accompanying Therapy for Advanced Gastric Cancer: Reasons for the Differences

The purpose of this study was to determine if international guidelines differ in their recommendations concerning additive therapy for advanced, but potentially curable, gastric cancer. A systematic search of the English and German literature was conducted in the databases Medline, Cochrane Database, Embase, and PubMed. The search terms used were 'guidelines gastric cancer,' 'guidelines stomach cancer,' and 'Leitlinien Magenkarzinom.' Six different guidelines published after January 1, 2010, in which the tumors were classified according to the seventh edition of the TNM system (2010), were identified. Although the examined guidelines were based on the same study results, their recommendations concerning accompanying therapy for gastric cancer differ considerably. While perioperative chemotherapy is recommended in Germany, Great Britain, and large parts of Europe, postoperative adjuvant radiochemotherapy or perioperative chemotherapy is recommended in the USA and Canada. In Japan, postoperative adjuvant chemotherapy is recommended.The results of identical studies were interpreted differently in different countries. Since considerable effort is required for each country to separately test relevant studies for their validity and suitability, an international cooperation could simplify the creation of a common basis for guidelines and contribute to improved comparability of international guidelines.

Perioperative Assistant Therapy of Liver Transplantation for Primary Hepatocellular Carcinoma / 中国普外基础与临床杂志

Objective To analyse the current situation and advance in perioperative therapy of liver transplantation for primary hepatocellular carcinoma(HCC).Methods The published papers on current situation and advance in the perioperative therapy of liver transplantation for HCC were reviewed.Results The survival rate of liver transplantation for HCC in early stage has been the same as that for benign liver diseases up to now. However, it is still a difficult problem to improve the survival rate of liver transplantation for advanced HCC. The ideal perioperative therapies of liver transplantation for HCC should be helpful to suppress the growth of tumor while the HCC patients are waiting for donated livers, to diminish or eliminate the intraoperative spread or implantation of tumor cells and to repress the micrometastasis postoperatively. The current perioperative therapies of liver transplantation for HCC include hepatic arterial chemoembolization, systemic chemotherapy, radiotherapy, percutaneous ethanol injection into HCC and radiofrequency ablation etc. Conclusion The perioperative assistant therapy of HCC can not only save time for patients before liver transplantation but also improve the survival rate after operation.