Function-preserving surgery for gastric cancer.
Early gastric cancer (EGC) with 5-year survival rates exceeding 90% now accounts for nearly 50% of all gastric cancers treated at major institutions in Japan. D2 lymphadenectomy with resection of at least two-thirds of the stomach has been the mainstay of treatment for every stage of gastric cancer, including EGC. Post-gastrectomy syndrome is inevitable after surgery. Most of the symptoms resolve with time, though some patients suffer immensely for prolonged periods. Mucosal cancers rarely metastasize (3% or less). Surgeons have altered the traditional strategy for treatment which focused only on highly radical operations. The new strategy preserves patients' quality of life, while at the same time maintaining a high level of radicality, by employing a function-preserving operation which prevents post-gastrectomy syndrome. The Japanese gastric cancer treatment guidelines have standardized indications for the function-preserving surgery that is widely performed in Japan. There are various kinds of function-preserving operations, such as those reducing the extent of gastrectomy, and those providing nerve preservation, sphincter preservation, and formation of a new-stomach. Evaluation of preserved function is not satisfactory, because there is no gold standard for measuring gastrointestinal motor function and patients' quality of life.
Katai
Hitoshi
H
Department of Surgical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. hkatai@ncc.go.jp
D005069:Evaluation Studies as Topic; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D005746:Gastric Emptying; D005773:Gastroscopy; D006801:Humans; D007564:Japan; D008197:Lymph Node Excision; D011178:Postgastrectomy Syndromes / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D016019:Survival Analysis