Trends in characteristics of surgically treated early gastric cancer patients after the introduction of gastric cancer treatment guidelines in Japan

Abstract

The gastric cancer treatment guidelines (Guidelines) of the Japanese Gastric Cancer Association allow endoscopic treatment and a modified gastrectomy for the treatment of early gastric cancer (EGC). Endoscopic treatment is indicated for EGC with a minimal chance of nodal metastasis. Consequently, surgeons will likely treat an increasing number of EGC patients with greater chance of nodal metastasis using a reduced extent of lymphadenectomy. The aim of this study was to investigate the trends in characteristics and long-term oncological outcomes of surgically treated EGC patients after the introduction of the Guidelines. Between 2001 and 2003, 696 patients underwent a gastrectomy according to the Guidelines. These 696 patients (the Guidelines group) were retrospectively compared with 635 patients (the control group) who had undergone a gastrectomy between 1991 and 1995 (before the introduction of the Guidelines). The incidence of nodal metastasis in mucosal cancers was higher in the Guidelines group than in the control group (6.5% vs 2.6%). The proportion of D2 or greater extended lymphadenectomy in the Guidelines group was lower than that in the control group (29.7% vs 62.5%). Nevertheless, the 5-year survival rate in the Guidelines group was similar to that in the control group (94.2% vs 92.3%). Surgeons treated more cases of mucosal cancer with nodal metastasis after the introduction of the Guidelines. The long-term oncological outcomes for patients with EGC remained excellent. So far, the Guidelines for the treatment of EGC appear acceptable.