New Wave in Japanese Surgery―Search for Standard Treatment Mitsuru Sasako 1 1Surgical Operation Division, The National Cancer Center Keyword: 標準治療 , 標準的手術 , 胃癌治療ガイドライン , D2 郭清 pp.83-88
Published Date 2003/1/25
DOI https://doi.org/10.11477/mf.1403101007
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 In the first edition of the Guidelines of the Japanese Gastric Cancer Association, EMR, limited surgery A and B are, for the first time, officially recognized as standard treatment options for early gastric cancers. Omentectomy and bursectomy, which used to be a part of standard D2 dissection, may be omitted for early lesions. The standard procedure for T2/3 lesions is clearly described as gastrectomy of two thirds or more of the stomach combined with D2 lymphadenectomy. Combined resection of adjacent organs for T4 is a part of the standard procedure, but that for lymphadenectomy is not included. D3 dissection remains as an experimental treatment. In the West, on the other hand, the “standard” procedure for curable tumors is uniformly decided irrespective of tumor stage and there is no option described for early lesions. It is interesting that D2 dissection is still the preferred procedure despite the results of the two major RCTs in the West.

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