Progress in gastric cancer surgery in Japan and its limits of radicality

Abstract

Abstract Radical surgery of gastric cancer has become more widely utilized in Japan. Topics explored in gastric cancer surgery include the extended lymph node dissection guided by the node staining method with India ink, left upper abdominal organs exenteration for advanced cancer of the upper stomach, and pancreaticoduodenectomy for advanced cancer of the lower stomach. Through the progress of surgical treatment as well as that of the early detection system, the treatment results have been improved. Using the data from nationwide registrations (5,706 and 11,845 cases) and those from the National Cancer Center Hospital (3,176 cases), the 5‐year survival rate of total primary resected cases was 44.3% in the first period (1963–1966), 56.3% in the second period (1969–1973), and 61.6% in the third period (1971–1985). Between the first and the third period, the 5‐year survival rate of patients with stage 2 cancer increased from 60.6% to 71.7%, and that of stage 3 increased from 32.7% to 44.3%; however, the limits of radical surgery were also clarified, especially in patients with peritoneal dissemination, liver metastasis, distant lymph node metastasis, and diffusely infiltrating carcinoma (Borrmann type 4). For such patients, chemotherapy, hormonal therapy, immunotherapy, radiotherapy, and hyperthermia should possibly be employed in hopes of improving treatment result .