Evaluation of Type Oriented Surgery According to the Stage of Gastric Cancer and Future Problems

Kiyoshi Sawai, Toshio Takahashi, Osamu Kojima, Toshiharu Yamaguchi, Tetsuro Yamane, Akeo Hagiwara, Hiroki Taniguchi, Masataka Shomotsuma, Tsuguo Fujioka, Hiroshi Minato, Miyakatsu Ohara

First Department of Surgery, Kyoto Prefectural University of Medicine

To improve the results of gastric cancer surgery, we adopted the following six policies in 1985: 1) preoperative staging using computed tomography, echography and angiography; 2) type-oriented surgery according to the stage of the cancer; 3) surgery without blood transfusion if possible; 4) reasonable lymph node dissection using activated carbon particles (CH40); 5) intra-peritoneal administration of mitomycin C adsorbed onto activated carbon (MMC-CH) for peritoneal dissemination; and 6) intraaterial infusion chemotherapy for liver metastasis. The five-year survival rare for gastric cancer patients who underwent gastrectomy under these six policies between 1985 and 1992 was 64.6%, which was significantly higher than that (46.4%) for patients who underwent gastrectomy between 1970 and 1984. 2. The differences in survival rates between the two groups were significant for patients with stage II and III gastric cancer. To secure a good quality of life after gastrectomy, we adopted pylorus preserving gastrectomy with lymph node dissection for early gastric cancer located in the middle third of the stomach in 1991. The occurrences of dumping syndrome and weight loss were lower in patients who underwent pylorus preserving gastrectomy than in patients who underwent subtotal gastrectomy. We have two future problems. Effect of para-aortic lymph node dissection should be proved by a randomized control study, and treatment for patients who have more than two unresectable factors should be developed.

Key words
type oriented surgery for gastric cancer, pyrolus preserving gastrectomy, future problem of gastric cancer surgery

Reprint requests
Kiyoshi Sawai First Department of Surgery, Kyoto Prefectural University of Medicine
465 Kajiicho, Kawaramachi, Kamigyoku, Kyoto, 602 JAPAN

Accepted
December 8, 1993

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