Current Treatment Strategies for Early Gastric Cancer

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Most surgeons in Japan have long considered extended lymphadenectomy (D2 dissection) as an essential part of surgical treatment for gastric cancer (GC) to clear completely the possible involved nodes. Accordingly, more than two-thirds gastrectomy is thought to be a necessary procedure, even for early gastric cancer (EGC). This radical surgery for EGC can,as a consequence,achieve excellent 5-year survival rates of greater than 90% [1,2]. The accumulation of EGC patient records undergoing a D2 dissection, both from individual institutional records [3–10] and from a nation-wide archive [11], subsequently revealed that the incidences of positive nodes among mucosal and submucosal GC, respectively, ranged from 1.8%–5% to 10%–25%. However, almost all node-positive mucosal GC patients and approximately 70% of node-positive submucosal GC patients exhibited perigastric node involvement, suggesting that EGC rarely spreads beyond the perigastric area. These site-specific analyses of positive nodes have subsequently changed the concept of surgical strategy for EGC in that a uniform D2 dissection is not always necessary. On the other hand, it has been established that various degrees of physiological and nutritional disorders develop in a large proportion of patients following gastrectomy. These postgastrectomy sequelae include early and late dumping syndromes, reflux esophagitis and gastritis, alkaline regurgitation, weight loss, malabsorption, vitamin and mineral deficiencies, anemia, and metabolic bone diseases [12]. These sequelae are often symptomatic and cannot be ignored. Gastrectomy in association with a certain amount of lymphadenectomy results in a loss or decreased reservoir size, abnormalities in gastric emptying (either too rapid or delayed), a loss of pyloric function that causes alkaline regurgitation, decreased caloric intake, and a loss of gastric motility. Each status, sometimes in combination or sometimes as a group, is responsible for the postgastrectomy sequelae, which often aggravate the patient’s postoperative quality of life. Against the background of the above excellent surgical outcomes and preferential node involvement in most EGC patients, current surgical trends for EGC have shifted