Treatment strategy of limited surgery in the treatment guidelines for gastric cancer in Japan

Surgical practice for gastric cancer in Japan is based on the Gastric Cancer Treatment Guidelines issued in 2001 by the Japanese Gastric Cancer Association. These recommendations list options for treatment of each stage of cancer, with clear distinctions between interventions recommended for routine...

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Bibliographic Details
Published in:The lancet oncology 2003-07, Vol.4 (7), p.423-428
Main Authors: Yokota, Takashi, Ishiyama, Shuichi, Saito, Toshihiro, Teshima, Shin, Shimotsuma, Masataka, Yamauchi, Hidemi
Format: Article
Language:English
Subjects:
Dissection
Gastrectomy - methods
Gastric cancer
Gastrointestinal surgery
Humans
Japan
Laparoscopy - methods
Laparotomy
Ligaments
Lymph Node Excision
Lymphatic system
Metastasis
Patients
Prognosis
Quality of Life
Stomach Neoplasms - classification
Stomach Neoplasms - pathology
Stomach Neoplasms - surgery
Surgeons
Survival Rate
Treatment Outcome
Veins & arteries
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Summary:Surgical practice for gastric cancer in Japan is based on the Gastric Cancer Treatment Guidelines issued in 2001 by the Japanese Gastric Cancer Association. These recommendations list options for treatment of each stage of cancer, with clear distinctions between interventions recommended for routine use and those that should be confined to trial settings until further evidence for their curative potential becomes available. In this review, we discuss standard surgery, local resection, segmental resection, and pylorus-preserving gastrectomy (PPG) as examples of limited resection and describe in detail the indications for limited lymph-node dissection in cases of early-stage gastric cancer. At present, evidence does not support the conclusion that limited surgery is effective for local resection or for improving quality of life. Thus, use of limited surgery should be considered an experimental approach both in Japan and the West. We conclude that surgeons who are familiar with the criteria for selecting surgical procedures should decide on a case-by-case basis which technique is most appropriate. Choices should be made with consideration of the stage of the cancer, invasiveness of the surgical procedure, and the patient's history. For all procedures, the patient must give informed consent and the surgeons must accurately assess the success of the operation after surgery.
ISSN:1470-2045
1474-5488
DOI:10.1016/S1470-2045(03)01140-9