[Perspectives on the standardization of surgical treatment for gastric cancer]

To obtain better outcomes of surgical treatment for gastric cancer, standardization of three major aspects, indications for treatment, surgical technique, and evaluation of the results are required. The practice guidelines for gastric cancer treatment postulated by the Japanese Gastric Cancer Association in 2001 provide optimal indications for treatment, but do not comment on the level of surgical technique and method to evaluate the results. Technical training has been performed in the traditional fashion based on apprenticeship in Japan, and there is no standardized evaluation system of the level of technique. Therefore guarantees of the level of surgical technique should be offered by medical societies and/or authorized associations. Surgical education using simulation system is a promising tool for standardization of the level of surgical technique. In the evaluation of the results of gastrectomy, the survival rate has been widely accepted as an objective evaluation. On the other hand, due to recent advances in the surgical treatment of gastric cancer and the increasing number of cases of early gastric cancer, attention has been paid not only to the survival rate but also to the quality of life(QOL) after gastrectomy. However, the general rules for evaluation of QOL have not been established. The standardization of surgical treatment of gastric cancer based on the estimation of these three aspects may offer a better prognosis and better QOL after gastrectomy.