Surgical treatment for gastric cancer: the Japanese approach

Present status of gastric cancer surgery in Japan and several new procedures are reviewed in this article. Japanese treatment results of this disease were significantly better than Western results even when stages were adjusted. Generally speaking, Japanese surgical procedures are more aggressive and meticulous compared with the Western approach, and these attitudes have produced the difference in survival. Particularly, systematic lymph node (LN) dissection is included as a standard procedure, and the adjacent organs are frequently resected when tumor invades them. The latest topics in surgery are the transdiaphragmatic approach for procedures in the mediastinum, para-aortic LN dissection, computer-assisted rational lymphadenectomy, LN imaging for complete dissection, removal of the peritoneum, and hyperthermo-chemotherapy for peritoneal carcinomatosis. Consideration of postoperative quality of life (QOL) is a new trend, and many interesting procedures have been proposed to maintain QOL, such as endoscopic mucosal resection and laparoscopic wedge resection for early cancer, pylorus-preserving gastric resection to reduce dumping syndrome, pancreas-preserving total gastrectomy to reduce fistula and postoperative diabetes.