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Progress in gastric cancer surgery in Japan and its limits of radicality

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Abstract

Radical surgery of gastric cancer has become more widely utilized in Japan. Topics explored in gastric cancer surgery include the extended lymph node dissection guided by the node staining method with India ink, left upper abdominal organs exenteration for advanced cancer of the upper stomach, and pancreaticoduodenectomy for advanced cancer of the lower stomach. Through the progress of surgical treatment as well as that of the early detection system, the treatment results have been improved. Using the data from nationwide registrations (5,706 and 11,845 cases) and those from the National Cancer Center Hospital (3,176 cases), the 5-year survival rate of total primary resected cases was 44.3% in the first period (1963–1966), 56.3% in the second period (1969–1973), and 61.6% in the third period (1971–1985). Between the first and the third period, the 5-year survival rate of patients with stage 2 cancer increased from 60.6% to 71.7%, and that of stage 3 increased from 32.7% to 44.3%; however, the limits of radical surgery were also clarified, especially in patients with peritoneal dissemination, liver metastasis, distant lymph node metastasis, and diffusely infiltrating carcinoma (Borrmann type 4). For such patients, chemotherapy, hormonal therapy, immunotherapy, radiotherapy, and hyperthermia should possibly be employed in hopes of improving treatment result.

Résumé

La chirurgie radicale pour traiter le cancer gastrique est devenue plus aggressive au fil des ans. Les thèmes a atteindre furent les suivants: dissection ganglionnaire étendue quidée par la méthode de coloration des ganglions à l'encre indienne, exentération des organes de la partie haute de l'abdomen pour le cancer évolué haut situé, et duodéno-pancréatectomie pour le cancer bas situé. Grâce aux progrès du traitement chirurgical et aux méthodes de détection précoce les résultats du traitement se sont améliorés. Employant les données du registre national (5,706 et 11,845 cas) et ceux du Centre National Hospitalier du Cancer (3,176 cas), le taux total de survie à 5 ans des cas réséqués a été de 44.3% de 1963 à 1966, de 56.3% de 1969 à 1973, et de 61.6% de 1971 à 1985. Entre la première et la troisième période, le taux de survie à 5 ans du cancer stade II s'est élevé de 60.6% à 71.7%, et celui du stade III de 32.7% à 44.3%. En outre, les limites de la chirurgie radicale ont été précisées spécialement chez les malades qui présentent une carcinose péritonéale, des métastases hépatiques, des métastases ganglionnaires à distance ou un cancer infiltrant diffus (Borrmann type IV). Chez de tels sujets la chimiothérapie, l'hormonothérapie, l'immunothérapie, la radiothérapie, l'hyperthermie doivent être également employées pour essayer d'améliorer les résultats du traitement.

Resumen

La cirugía radical del cancer gástrico se ha extendido en el Japón. Tópicos recientes sobre cirugía del cáncer gástrico han sido la disección ganglionar amplia guiada por “el método de tinción ganglionar con tinta china,” “la exenteración de los órganos abdominales superiores izquierdos” para cáncer avanzado, y la pancreatoduodenectomía para los cánceres avanzados inferiores. Gracias al progreso en el tratamiento quirúrgico, así como en el sistema de detección precoz, se ha logrado mejorar los resultados terapéuticos. Utilizando los datos de registros nacionales (5,706 y 11,845 casos) y los del Hospital Centro Nacional de cáncer (3,176 casos), la tasa de supervivencia a 5 a∼nos del total de casos de resección primaria fue de 44.3% en el primer periodo (1963–1966), de 56.3% en el segundo periodo (1969–1973), y de 61.6% en el tercer periodo (1971–1985). Entre el primera y el tercer periodo la tasa de supervivencia a 5 anos para los estados 2 ascendió de 60.6% a 71.7%, y la de los estados 3 de 32.7% a 44.3%. Sin embargo, hemos tenido que aceptar los límites de la cirugía en cuanto a radicalidad, especialmente en pacientes con metástasis peritoneales, metástasis hepáticas, metástasis ganglionares distales y cáncer del tipo 4 (Borrman tipo 4, carcinoma de infiltración difusa). Para tales pacientes la quimioterapia, la terapia hormonal, la inmunoterapia, la radioterapia, y la hipertemia son modalidades adicionales que deben ser utilizadas con el fin de mejorar los resultados terapéuticos.

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Supported in part by Grants-in-Aid for Cancer Research from the Ministry of Health and Welfare of Japan.

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Maruyama, K., Okabayashi, K. & Kinoshita, T. Progress in gastric cancer surgery in Japan and its limits of radicality. World J. Surg. 11, 418–425 (1987). https://doi.org/10.1007/BF01655804

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