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It's just like déjà vu. Japanese surgeons have often been dismissive of the value of adjuvant treatment for gastric cancer reported from Europe and America (1,2) because of differences in the degree of lymph node dissection between Japan and Europe/America (3). In contrast, Japanese surgeons may be surprised and delighted at the results of the National Surgical Adjuvant Study of Colorectal Cancer (NSAS-CC) of postoperative adjuvant chemotherapy for rectal cancer published in this issue of the JJCO (4), the results of which have not been so exciting for European and American oncologists. Such differences have resulted from attitudes towards the basic surgical procedures and the strategy of postoperative adjuvant treatment for rectal cancer.

In Europe and America, adjuvant therapy for rectal cancer has included radiotherapy as a standard. In Japan, postoperative chemotherapy has been the primary treatment mainly because of excellent outcomes of surgery including autonomic nerve-preserving D3 dissection (lateral lymphadenectomy). The latest National Comprehensive Cancer Network (NCCN) guidelines prescribe preoperative concomitant radiotherapy and chemotherapy (FU ± LV or Capecitabine) and postoperative chemotherapy (FU ± LV or FOLFOX or Capecitabine) or, when preoperative chemoradiotherapy was not given, postoperative concomitant radiotherapy and chemotherapy (FU ± LV or FOLFOX or Capecitabine) (5). The use of chemotherapy has been based on the evidence of postoperative adjuvant chemotherapy in colon cancer, not rectal cancer. As for radiotherapy, local recurrence was reduced but the survival rate not increased in most reports.

Issue Section:
Editorial
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