| [ Summary ] |
The gastric cancer treatment guidelines laid out by the Japanese Gastric Cancer Association define "standard gastrectomy" as resection of more than 2/3 of the stomach with D2 lymphadenectomy, and "extended surgery" as combined resection of adjacent organs and/or D3 dissection. The standards for D2 gastrectomy were established in Japan based on the analysis of a large database concerned with lymph node metastasis and patients' survival rates, and have become the gold standard for treatment of advanced gastric cancer. European randomized trials, however, failed to show survival benefits associated with D2. In T4 tumors, combined resection of invaded organs may provide a cure in the absence of extensive nodal metastasis. The roles of splenectomies or para-aortic lymphadenectomies, aiming at complete loco-regional tumor control, have not yet been established. Ongoing randomized trials by the Japan Clinical Oncology Group will provide evidence related to these therapies in the future. The treatment strategy for patients with non-resectable metastasis is only briefly described in the guidelines and is expected to be included in the future edition. |