Time trends of surgical treatment and the prognosis for Japanese patients with gastric cancer

Abstract

The incidence of gastric cancer is much higher in Japan than in other countries even though diagnostics and treatments of such patients have improved. The objective of this study was to present an overview of the past, present and future of surgical treatment for our patients with gastric cancer. We analysed data on 2152 Japanese men and women with gastric cancer who underwent surgical resection from 1965 to 1995 at Kyushu University in Fukuoka, Japan, based on a univariate and the multivariate analysis. We focused on time trends of surgical treatment and the postoperative outcome. Over the years, there have been favourable changes in the numbers of patients with early gastric cancer. In all cases of gastric cancer, the rate of 18% in the first six year period (group 1) was 57% in the last 5 year period (group 6). Size of the tumour was smaller, well-differentiated tumour tissue was more common, and lymphatic involvement was less frequent. Lymph node metastasis, liver metastasis and peritoneal dissemination all decreased. Extensive lymph node dissection was more frequently done and the rate of curative resection (curability A and B) increased. With increases in identifying the early stage of cancer and better perioperative care, mortality rates 30 days after the surgery greatly decreased. Multivariate analysis revealed that the 10 factors of depth of invasion, lymph node metastasis, lymph node dissection, tumour size, liver metastasis, peritoneal dissemination, lymphatic invasion, vascular invasion, lesion in the whole stomach and lesion in the middle stomach were independent factors for determining the prognosis. Detection of the tumour in an early stage, standardized surgical treatment, including routine lymph node dissection, close follow-up schedules and better perioperative management are expected to increase survival time for patients with this malignancy. © 2000 Cancer Research Campaign

Laparoscopy-assisted subtotal gastrectomy with very small remnant stomach: a novel surgical procedure for selected early gastric cancer in the upper stomach

“…The incidence of early gastric cancer (EGC) is increasing in Japan, and EGC now accounts for more than 50% of all gastric cancers [1]. Laparoscopic or laparoscopy-assisted gastrectomy (LAG) is now well accepted and widely used as a minimally invasive surgical treatment for EGC.…”

Lymphovascular invasion is an important predictor of lymph node metastasis in endoscopically resected early gastric cancers

“…With advances in diagnostic technologies and mass population screening, the proportion of early gastric cancer (egc) has rapidly and consistently increased, especially in Korea and Japan, over past decades (1)(2)(3). egc have a favorable prognosis, with 5-year survival rates exceeding 90%; however, the presence of lymph node (ln) metastasis significantly affects survival in these patients (84.6% in the ln-positive group vs. 96.2% in the ln-negative group) (1,4).…”

Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer

“…The incidence of early gastric cancer has been increasing for decades, reaching nearly 60% in Japan [1][2][3][4]. A conventional distal gastrectomy with lymph node dissection followed by Billroth-I -type reconstruction (DGBI) has been the accepted procedure for early gastric cancer in the middle third of the stomach [5].…”