Radical surgery of gastric cancer has become more widely utilized in Japan. Topics explored in gastric cancer surgery include the extended lymph node dissection guided by the node staining method with India ink, left upper abdominal organs exenteration for advanced cancer of the upper stomach, and pancreaticoduodenectomy for advanced cancer of the lower stomach. Through the progress of surgical treatment as well as that of the early detection system, the treatment results have been improved. Using the data from nationwide registrations (5,706 and 11,845 cases) and those from the National Cancer Center Hospital (3,176 cases), the 5-year survival rate of total primary resected cases was 44.3% in the first period (1963)(1964)(1965)(1966), 56.3% in the second period (1969)(1970)(1971)(1972)(1973), and 61.6% in the third period (1971)(1972)(1973)(1974)(1975)(1976)(1977)(1978)(1979)(1980)(1981)(1982)(1983)(1984)(1985). Between the first and the third period, the 5-year survival rate of patients with stage 2 cancer increased from 60.6% to 71.7%, and that of stage 3 increased from 32.7% to 44.3%; however, the limits of radical surgery were also clarified, especially in patients with peritoneal dissemination, liver metastasis, distant lymph node metastasis, and diffusely infiltrating carcinoma (Borrmann type 4). For such patients, chemotherapy, hormonal therapy, immunotherapy, radiotherapy, and hyperthermia should possibly be employed in hopes of improving treatment result.Japanese surgeons have made great efforts to improve the radical treatment of gastric cancer because cancer is the major cause of death in Japan (death rate = 125.5 in 1984), and gastric cancer is the most common malignancy (death rate = 41.7 in 1984). Obviously, improvements in early detection and treatment of gastric cancer were of utmost importance. The purpose of this article is to describe and discuss the present status of gastric cancer surgery in Japan. Standard Radical Operation in JapanTo evaluate the surgical treatment of gastric cancer, special consideration should be given to the characteristics of the Japanese. Most Japanese patients are slim, and their abdominal cavities are shallow. Severe heart, vascular, pulmonary, liver, renal, and metabolic failures are infrequent. This allows extended radical operations with few fatal postoperative complications.The techniques of radical operation [1] have been well

The incidence of metastases from gastric adenocarcinoma to various regional lymph node stations was studied after meticulous node dissection and correlated to survival in 1931 resected patients. The incidence of metastases increased with deeper tumor invasion into the stomach wall. Deposits were most common in some perigastric node stations, and their distribution was clearly related to the location of the tumor. Some nonperigastric node stations also were frequently involved, e.g., those around the left gastric artery or in the splenic hilum, and may be considered primary draining nodes. Skip metastases to distant nodes were found in a few per cent of perigastric node-negative patients. Deposits in nodes around the middle colic artery, but not in any other upper abdominal node stations, were incompatible with 5-year survival rates. The analysis favors a so-called R2 or more extensive resection for cancers invading beyond the submucosa.

No abstract

To evaluate retrospectively the surgical treatment of patients with gastric stump cancer following gastrectomy for benign disease, we reviewed 52 patients operated on at the National Cancer Centre, Tokyo, between 1962 and 1988. Resection was carried out in 47 patients (90 per cent) and with curative intent in 36 (69 per cent). Stage distribution was: stage 1, 15 patients; stage 2, 5; stage 3, 9; stage 4, 23. In 36 cases curatively resected, 32 had completion total gastrectomy and four had subtotal resection. An R1 resection was performed in 11 patients and an R2 in 25. We had two hospital deaths and a 5-year survival rate excluding hospital deaths of 39 per cent. The 5-year survival rates of resected cases, curative cases and those having metastatic nodes were 43 per cent, 57 per cent and 29 per cent respectively. Radical resection is a reasonable treatment for gastric stump cancer as it is for primary cancer of the stomach.

ASC of the lung is more aggressive than AC and SC. The decreased survival of patients with ASC as compared with either of those single histology tumors suggests the need for a clinical trial of adjuvant chemotherapy that includes early-stage patients.