title: The role of surgery in the current treatment of gastric carcinoma.
abstract: Surgery currently is the only curative option in the treatment of gastric cancer. For early gastric cancer, an endoscopic mucosal resection (EMR) is adequate for intramucosal cancer less than 2 cm in diameter without ulcer. For early cancers ineligible for EMR, limited surgical operation (proximal gastrectomy, segmental resection, and pylorus-preserving distal gastrectomy) can be recommended to reduce surgical risk and achieve improvements in quality of life without decreasing survival. Subtotal/total gastrectomy plus D2 lymph node dissection is the standard surgery for advanced gastric cancer in Japan. Pancreas-preserving total gastrectomy is recommended due to the reduced risk of pancreatic fistula and postoperative diabetes. Regarding extended surgery, results of a phase III study to evaluate the role of paraaortic node dissection will be analyzed in a few years' time after the accrual of more than 500 patients in a Japan Clinical Oncology Group (JCOG) study. For scirrhous gastric cancer, left upper abdominal exenteration appears to be associated with improved survival and should be tested in another controlled trial.
authors.affiliation: Department of Surgical Oncology, Sakai City Hospital, 1-1-1 Minamiyasui-cho, Sakai, Osaka 590-0064, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Furukawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kodera
mesh_terms: D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D004724:Endoscopy; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*