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Surgery Today
Published in: Surgery Today 10/2017

01-10-2017 | Original Article

Conversion surgery after combination chemotherapy of docetaxel, cisplatin and S-1 (DCS) for far-advanced gastric cancer

Authors: Hiroaki Mieno, Keishi Yamashita, Kei Hosoda, Hiromitsu Moriya, Katsuhiko Higuchi, Mizutomo Azuma, Shouko Komori, Tsutomu Yoshida, Satoshi Tanabe, Wasaburo Koizumi, Natsuya Katada, Masahiko Watanabe

Published in: Surgery Today | Issue 10/2017

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Abstract

Purpose

A triplet regimen of docetaxel, cisplatin, and S-1(DCS) is highly effective against metastatic gastric cancer. We performed this study to clarify the safety and efficacy of surgical resection in patients with initially unresectable gastric cancer, after down-staging or disease control was achieved by DCS chemotherapy.

Methods

The subjects of this retrospective study were 31 consecutive patients with initially unresectable gastric cancer, who underwent surgical resection between October, 2006 and December, 2012, after down-staging or disease control was achieved by DCS chemotherapy. We evaluated the clinicopathological factors and clinical outcomes and assessed radiographic response based on the RECIST criteria, not by central review.

Result

Before DCS chemotherapy, 18 patients had extra-regional lymph node metastasis, 5 had liver metastasis, 8 had macroscopic peritoneal metastasis, and 8 had pancreatic head invasion. Twenty-three (74.2%) of the 31 patients underwent R0 resection. Postoperative morbidity and mortality rates were 16.1 and 0%. During chemotherapy, grade 3/4 toxicities included neutropenia (54.8%), leukopenia (32.3%), and anemia (16.1%). Median progression-free survival and median overall survival (OS) were 42.1 and 56.1 months, respectively. These results were similar for all patients, except those with locally advanced disease alone. In the multivariate analysis for OS, ypN remained an independent negative prognostic factor (p = 0.018).

Conclusion

Surgical resection after DCS chemotherapy for initially unresectable gastric cancer was safe and provided a reasonable R0 resection rate and good mid-term survival.
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Metadata
Title
Conversion surgery after combination chemotherapy of docetaxel, cisplatin and S-1 (DCS) for far-advanced gastric cancer
Authors
Hiroaki Mieno
Keishi Yamashita
Kei Hosoda
Hiromitsu Moriya
Katsuhiko Higuchi
Mizutomo Azuma
Shouko Komori
Tsutomu Yoshida
Satoshi Tanabe
Wasaburo Koizumi
Natsuya Katada
Masahiko Watanabe
Publication date
01-10-2017
Publisher
Springer Japan
Published in
Surgery Today / Issue 10/2017
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-017-1512-z

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