Surgical Treatment of Gastric Cancer in Japan Trend from Standardization to Individualization

Japan has a huge number of patients with gastric cancer andhas developed various surgical treatments for this disease.This paper intends to introduce our strategies against gastriccancer. The Japanese Gastric Cancer Association wasestablished in 1962. Its major purposes are promotion ofbasic and clinical researches and popularization of the latestknowledge and technologies. For the purposes, the associationorganized the annual scientific meeting and the nationwideregistry by member hospitals, and published theJapanese Classification of Gastric Cancer (1) and theTreatment Guide Line (2). The nationwide registry reportedthat proportion of Stage-I cancer was 22.5% in 1963-66,which increased to 59.3% in 2008 (3,4,5). 11,261 patientswith gastric resection were registered by 187 hospitals in2008. 63 patients were died within 30 postoperative daysand the direct death rate was 0.55%. 5 year survival rate (5YSR) was 37.5% for resected cases in 1963-66, which wasimproved to 70.1% in 2008. 5YSR was improved from55.1% to 74.1% for Stage-II, and from 39.1% to 48.8% forStage-III in the period. According to remarkable increase ofearly stage cancer, principle of surgical treatments wasshifted from “extended and standardized surgery for radicality”to “reasonable and individual surgery considering safetyand quality of life”. This trend produced a large variation insurgical treatments; namely 1) minimally invasive surgeries,2) function preserving surgeries, 3) optimal extent of lymphnode dissection, and 4) aggressive but safe surgeries.Intention of this paper is to explain these procedures, theintentions, the indications, and the treatment results.

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