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
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References
Abe S, Lightdale CJ and Brennan MF (1993) The Japanese experience with endoscopic ultrasonography in the staging of gastric cancer. Gastrointest Endosc 39: 586–591
Alazraki NP, Eshima D, Eshima LA, Herda SC, Murray DR, Vansant JP and Taylor AT (1997) Lymphoscintigraphy, the sentinel node concept, and the intraoperative gamma probe in melanoma, breast cancer and other potential cancers. Semin Nucl Med 27: 55–67
Baba H, Maehara Y, Takeuchi H, Inutsuka S, Okuyama T, Adachi Y, Akazawa K and Sugimachi K (1995) Effect of lymph node dissection on the prognosis in patients with node-negative early gastric cancer. Surgery 117: 165–169
Bonenkamp JJ, Hermans J, Sasako M and van de Velde CJH the Dutch Gastric Cancer Group (1999) Extended lymph-node dissection for gastric cancer. N Engl J Med 340: 908–914
Bunt AMG, Hermans J, Boon MC, van de Velde CJH, Sasako M, Fleuren GJ and Bruijn JA (1994) Evaluation of the extent of lymphadenectomy in a randomized trial of Western- versus Japanese-type surgery in gastric cancer. J Clin Oncol 12: 417–422
Cox DR (1972) Regression models and life tables. J Royal Statist Soc Series B 34: 187–220
Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, Sydes M and Fayers P for the Surgical Co-operative Group (1999) Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Br J Cancer 79: 1522–1530
de Manzoni G, Verlato G, Guglielmi A, Laterza E, Genna M and Cordiano C (1996) Prognostic significance of lymph node dissection in gastric cancer. Br J Surg 83: 1604–1607
Dixon WJ (1988). BMDP Statistical Software, Berkeley: University of California Press
Fuch CS and Mayer RJ (1995) Gastric carcinoma. New Engl J Med 333: 32–41
Fukuya T, Honda H, Hayashi T, Kaneko K, Tateshi Y, Ro T, Maehara Y, Tanaka M, Tsuneyoshi M and Masuda K (1995) Lymph-node metastases: Efficacy of detection with helical CT in patients with gastric cancer. Radiology 197: 705–711
Guadagni S, Catarci M and de Manzoni G (1995) D1 versus D2 dissection for gastric cancer. Lancet 345: 1517
Hanazaki K, Sodeyama H, Wakabayashi M, Miyazaki M, Yokoyama S, Sode Y, Kawamura N, Miyazaki T and Ohtsuka M (1997) Surgical treatment of gastric cancer detected by mass screening. Hepato-gastroenterol 44: 1126–1132
Hisamichi S (1989) Screening for gastric cancer. World J Surg 13: 31–7
Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma -2nd English edition-. Gastric Cancer 1: 10–24
Jentschura D, Heubner C, Manegold BC, Rumstadt B, Winkler M and Trede M (1997) Surgery for early gastric cancer: A European one-center experience. World J Surg 21: 845–849
Kaneko E, Nakamura T, Umeda N, Fujino M and Niwa H (1977) Outcome of gastric carcinoma detected by gastric mass survey in Japan. Gut 18: 626–630
Kawasaki S (1975) A clinicopathological study on upward intramural extension of cancer of the stomach. Fukuoka Acta Medica 66: 1–23, (in Japanese with English Abstract)
Kitano S, Shimoda K, Miyahara M, Shiraishi N, Bandoh T, Yoshida T, Shuto K and Kobayashi M (1995) Laparoscopic approaches in the management of patients with early gastric carcinomas. Surg Laparosc Endosc 5: 359–362
Kodama Y, Sugimachi K, Soejima K, Matsusaka T and Inokuchi K (1981) Evaluation of extensive lymph node dissection for carcinoma of the stomach. World J Surg 5: 241–248
Korenaga D, Okamura T, Baba H, Saito A and Sugimachi K (1988) Results of resection of gastric cancer extending to adjacent organs. Br J Surg 75: 12–15
Maehara Y, Moriguchi S, Kakeji Y, Orita H, Haraguchi M, Korenaga D and Sugimachi K (1991) Prognostic factors in adenocarcinoma in the upper one-third of the stomach. Surg Gynecol Obstet 173: 223–226
Maehara Y, Okuyama T, Moriguchi S, Orita H, Kusumoto H, Korenaga D and Sugimachi K (1992) Prophylactic lymph node dissection in patients with advanced gastric cancer promotes increased survival time. Cancer 70: 392–395
Maehara Y, Okuyama T, Oshiro T, Baba H, Anai H, Akazawa K and Sugimachi K (1993) Early carcinoma of the stomach. Surg Gynecol Obstet 177: 593–597
Maehara Y, Oshiro T, Oiwa H, Oda S, Baba H, Akazawa K and Sugimachi K (1995a) Gastric cancer in patients over 70 years of age. Br J Surg 82: 102–105
Maehara Y, Oshiro T, Baba H, Ohno S, Kohnoe S and Sugimachi K (1995b) Lymphatic invasion and potential for tumor growth and metastasis in patients with gastric cancer. Surgery 117: 380–385
Maehara Y, Yamamoto M, Oda S, Baba H, Kusumoto T, Ohno S, Ichiyoshi Y and Sugimachi K (1996a) Cytokeratin-positive cells in bone marrow for identifying distant micrometastasis of gastric cancer. Br J Cancer 73: 83–87
Maehara Y, Emi Y, Baba H, Adachi Y, Akazawa K, Ichiyoshi Y and Sugimachi K (1996b) Recurrences and related characteristics of gastric cancer. Br J Cancer 74: 975–979
Maehara Y, Oshiro T, Endo K, Baba H, Oda S, Ichiyoshi Y, Kohnoe S and Sugimachi K (1996c) Clinical significance of occult micrometastasis in lymph nodes from patients with early gastric cancer who died of recurrence. Surgery 119: 397–402
Maehara Y, Tomoda M, Tomisaki S, Ohmori M, Baba H, Akazawa K and Sugimachi K (1997) Surgical treatment and outcome for node-negative gastric cancer. Surgery 121: 633–639
Maehara Y, Hasuda S, Abe T, Oki E, Kakeji Y, Ohno S and Sugimachi K (1998) Tumor angiogenesis and micrometastasis in bone marrow of patients with early gastric cancer. Clin Cancer Res 4: 2129–2134
Maehara Y, Kakeji Y, Kabashima A, Emi Y, Watanabe A, Akazawa K, Baba H, Kohnoe S and Sugimachi K (1999) Role of transforming growth factor-β1 in invasion and metastasis in gastric carcinoma. J Clin Oncol 17: 607–614
McCulloch P (1995) D1 versus D2 dissection for gastric cancer. Lancet 345: 1516–1517
Moreaux J and Bougaran J (1993) Early gastric cancer. A 25-year surgical experience. Ann Surg 217: 347–355
Noguchi Y, Imada T, Matsumoto A, Coit DG and Brennan MF (1989) Radical surgery for gastric cancer. A review of the Japanese experience. Cancer 64: 2053–2062
Okamura T, Tsujitani S, Korenaga D, Haraguchi M, Baba H, Hiramoto Y and Sugimachi K (1988) Lymphadenectomy for cure in patients with early gastric cancer and lymph node metastasis. Am J Surg 155: 476–480
Pacelli F, Doglietto GB, Bellantone R, Alfieri S, Sgadari A and Crucitti F (1993) Extensive versus limited lymph node dissection for gastric cancer: a comparative study of 320 patients. Br J Surg 80: 1153–1156
Robertson CS, Chung SCS, Woods SDS, Griffin SM, Raimes SA, Lau JTF and Li AKC (1994) A prospective randomized trial comparing R1 subtotal gastrectomy with R3 total gastrectomy for antral cancer. Ann Surg 220: 176–182
Roukos DH, Hottenrott C, Lorenz M and Koutsogiorgas-Couchell S (1990) A critical evaluation of effectivity of extended lymphadenectomy in patients with carcinoma of the stomach. J Cancer Res Clin Oncol 116: 307–313
Sakamoto J and Yasue M (1995) Extensive lymphadenectomy for gastric cancer patients: what can the results of one trial tell us?. Lancet 345: 742–743
Sano T, Kobori O and Muto T (1992) Lymph node metastasis from early gastric cancer: endoscopic resection of tumour. Br J Surg 79: 241–244
Schlimok G, Funke I, Pantel K, Strobel F, Lindemann F, Witte J and Riethmüller G (1991) Micrometastatic tumour cells in bone marrow of patients with gastric cancer: Methodological aspects of detection and prognostic significance. Eur J Cancer 27: 1461–1465
Siewert JR, Böttcher K, Roder JD, Busch R, Hermanek P and Meyer HJ the German Gastric Carcinoma Study Group (1993) Prognostic relevance of systematic lymph node dissection in gastric carcinoma. Br J Surg 80: 1015–1018
Siewert JR, Kestlmeier R, Busch R, Böttcher K, Roder JD, Müller J, Fellbaum C and Höfler H (1996) Benefits of D2 lymph node dissection for patients with gastric cancer and pN0 and pN1 lymph node metastases. Br J Surg 83: 1144–1147
Sue-Ling HM and Johnston D (1995) D1 versus D2 dissection for gastric cancer. Lancet 345: 1515–1516
Sue-Ling HM, Johnston D, Martin IG, Dixon MF, Lansdown MRJ, McMahon MJ and Axon ATR (1993) Gastric cancer: a curable disease in Britain. Gut 307: 591–596
Wu C-W, Hsieh M-C, Lo S-S, Wang L-S, Hsu W-H, Lui W-Y, Huang M-H and P’eng F-K (1995) Morbidity and mortality after radical gastrectomy for patients with carcinoma of the stomach. J Am Coll Surg 181: 26–32
Yoshimori M (1989) The natural history of early gastric cancer. Jpn J Clin Oncol 19: 89–93
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Maehara, Y., Kakeji, Y., Oda, S. et al. Time trends of surgical treatment and the prognosis for Japanese patients with gastric cancer. Br J Cancer 83, 986–991 (2000). https://doi.org/10.1054/bjoc.2000.1427
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DOI: https://doi.org/10.1054/bjoc.2000.1427
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