Surgery for gastric cancer: 10-year experience worldwide

Abstract

extended lymph node dissection has been traditional in Japan, and critical studies from several Western countries suggest that there are improved surgical results after extended lymph node dissection. Therefore, it is important to evaluate the current information on the clinical and pathological characteristics of, and the surgical results for gastric cancer worldwide.To demonstrate recent experience of gastric cancer surgery throughout the world and to evaluate modern strategies for the treatment of gastric cancer, we investigated the English-language literature of the past 10 years, reviewed more than 100 studies concerning controversial issues in gastric cancer treatment, and assessed the current status of gastric cancer surgery worldwide. This review was generally based on promising papers published in well known medical journals, and focused on the following items: (1) surgical results worldwide, (2) lymph node metastasis, (3) lymph node dissection, (4) splenectomy, (5) prognostic factors, and (6) new therapeutic trends. Surgical results worldwideThe review of English-language publications from 1970 to 1990 showed that the operative mortality rate following surgery for gastric cancer had declined to a mean of 8% and a median of 5% [1]. In the British hospital, operative mortality decreased from 15% to 7%, and the 5-year survival rate increased from 5% to 11% [2]. In another British hospital, the proportion of patients with early gastric cancer rose from 1% to 15%, that of stage I disease rose from 4% to 26%, and that of potentially curative resection rose from 31% to 53% [3]. After curative resection, the 5-year survival rate was 60%, and the operative mortality and morbidity rates were 6% and 17%, respectively.In Sweden, the 5-year surival rate after gastrectomy for cancer increased from 19% to 25%, mainly owing to Abstract To demonstrate recent experience of gastric cancer surgery worldwide and to evaluate modern strategies for the treatment of gastric cancer, we investigated the English-language literature of the past 10 years, based on papers published in well-known medical journals. In many countries, the increased detection of early gastric cancer, advanced operative procedures, and careful postoperative management have improved the surgical results of gastric cancer over the years. Although randomized controlled trials in Europe showed no survival benefit of D2 resection over D1 resection, the results must be interpreted with caution and cannot be extrapolated to Japanese patients, because the morbidity and mortality after D2 gastrectomy in Japan are much less than those after D1 gastrectomy in Europe. Recently, less invasive treatments, including endoscopic mucosal resection and laparoscopic gastrectomy, have become feasible for patients with early gastric cancer, but their risks and benefits compared with traditional gastrectomy are unclear.

Clinical Outcome after D1 vs D2–3 Gastrectomy for Treatment of Gastric Cancer

“…The results of extended lymphadenectomy have been good in Japan: the five-year survival has been about 60-66% among curatively operated gastric cancer patients,and postoperative mortality has been less than 3% (6-7, 11,13,27). In randomised European studies the results after extended lymphadenectomy have been less encouraging: the five-year survival has varied between 33 to 47% among patients having undergone extended lymphadenectomy, and no statistical differences in survival between D1 and D2 operated patients have been observed (14-15, 21, 28).…”

Irregular bowel movement in gastrectomized subjects: bowel habits, stool characteristics, fecal flora, and metabolites

“…Advances in surgical procedures have improved the prognostic results of gastric cancer treatment [1]. However, very few effective strategies have been established to control postgastrectomy sequelae.…”

Impact of plasma tissue inhibitor of metalloproteinase-1 on long-term survival in patients with gastric cancer

“…Although the mortality has gradually decreased with an increasing incidence in the detection of early-stage disease in Japan, more than 50% of advanced cases recur, even after a curative resection [2]. The prognosis is extremely poor in patients with recurrent or unresectable gastric cancer [3].…”