title: Original article: role of adjuvant chemotherapy in a perioperative chemotherapy regimen for gastric cancer.
abstract: Multimodal treatment strategies - perioperative chemotherapy (CTx) and radical surgery - are currently accepted as treatment standard for locally advanced gastric cancer. However, the role of adjuvant postoperative CTx (postCTx) in addition to neoadjuvant preoperative CTx (preCTx) in this setting remains controversial.
  
  
  
  Between 4/2006 and 12/2013, 116 patients with locally advanced gastric cancer were treated with preCTx. 72 patients (62 %), in whom complete tumor resection (R0, subtotal/total gastrectomy with D2-lymphadenectomy) was achieved, were divided into two groups, one of which receiving adjuvant therapy (n = 52) and one without (n = 20). These groups were analyzed with regard to survival and exclusion criteria for adjuvant therapy.
  
  
  
  Postoperative complications, as well as their severity grade, did not correlate with fewer postCTx cycles administered (p = n.s.). Long-term survival was shorter in patients receiving postCTx in comparison to patients without postCTx, but did not show statistical significance. In per protocol analysis by excluding two patients with perioperative death, a shorter 3-year survival rate was observed in patients receiving postCTx compared to patients without postCTx (3-year survival: 71.2 % postCTx group vs. 90.0 % non-postCTx group; p = 0.038).
  
  
  
  These results appear contradicting to the anticipated outcome. While speculative, they question the value of post-CTx. Prospectively randomized studies are needed to elucidate the role of postCTx.
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Lichthardt
authors.affiliation: Comprehensive Cancer Centre Mainfranken, University Hospital, University of Wuerzburg, Josef-Schneiderstr. 6, 97080, Wuerzburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kerscher
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany.
authors.forename: Ulrich A
authors.initials: UA
authors.lastname: Dietz
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Jurowich
authors.affiliation: Comprehensive Cancer Centre Mainfranken, University Hospital, University of Wuerzburg, Josef-Schneiderstr. 6, 97080, Wuerzburg, Germany.|Department of Internal Medicine II, University of Wuerzburg Medical Center, Oberduerrbacherstr.2, 97080, Wuerzburg, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Kunzmann
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany.
authors.forename: Burkhard H A
authors.initials: BH
authors.lastname: von Rahden
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany.|Comprehensive Cancer Centre Mainfranken, University Hospital, University of Wuerzburg, Josef-Schneiderstr. 6, 97080, Wuerzburg, Germany.
authors.forename: Christoph-Thomas
authors.initials: CT
authors.lastname: Germer
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany. wiegering_a@ukw.de.|Department of Biochemistry and Molecular Biology, University of Wuerzburg, Am Hubland, 97074, Wuerzburg, Germany. wiegering_a@ukw.de.
authors.forename: Armin
authors.initials: A
authors.lastname: Wiegering
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Adjuvant; Chemotherapy; Complication; Gastric cancer; Multimodal; Neoadjuvant; Risk factor; Survival