Update on surgery of gastric cancer: new procedures versus standard technique

D2 lymphadenectomy has been the mainstay of treatment for every stage of gastric cancer including early gastric cancer in Japan. However, the use of conventional D2 nodal dissection is being challenged. There was a recent improvement in techniques for preoperative diagnosis and perioperative diagnosis. Less extensive surgeries to maintain patients' quality of life have been introduced as standard treatment for some forms of early gastric cancer in the Gastric Cancer Treatment Guidelines 2001 (The Japanese Gastric Cancer Association). Superextended dissection (more than D2) for non-early gastric cancer is set at investigational treatment. Japanese surgeons are now aiming at wide variations of surgical treatment according to the stage of disease based on new procedures. Further evaluations are proceeding to prove superior to standard techniques.