Surgical treatment of early gastric cancer

Around half the cases of gastric cancer are found in the early stage in Japan. With an expected good prognosis, many treatment options have been developed to maintain a good quality of life of the patients after the treatment. Gastric cancer is diagnosed with endoscopy, and the depth of invasion is diagnosed with endoscopy and endoscopic ultrasound. One of the new treatments is endoscopic submucosal dissection. Improvements in surgical treatment are minimizing lymph node dissection, reconstruction methods, laparoscopy-assisted surgery, and sentinel node navigation surgery. Minimizing lymph node dissection for early gastric cancer is well described in the Guidelines for Gastric Cancer Treatments. Pylorus-preserving gastrectomy, jejunal interposition, pouch reconstruction, and Roux-en-Y reconstruction after distal gastrectomy are improvements in reconstruction after gastrectomy. More and more surgeons start laparoscopy-assisted gastrectomy with lymph node dissection. Even with these improvements, the 5-year survival of early gastric cancer is more than 90% in Japan. Further improvements would be possible in the future.