Features of Treatment of Gastric Cancer in Niigata -Rational Surgery for Early Gastric Cancer-

Atsushi Nashimoto, Hiroshi Yabusaki, Haruhiko Makino, Yoshiaki Tsuchiya, Mitsuhiro Tsutsui, Otsuo Tanaka, Juei Sasaki

Division of Surgery, Niigata Cancer Center Hospital

Gastric cancer occurs frequently in Niigata prefecture. Niigata Cancer Center Hospital is one of the central hospitals in Niigata and about 10% of gastric cancer patients in Niigata are operated on there. Rational surgery (RS) was used for early gastric cancer, and long-term survival and quality of life (QOL) were evaluated according to the method of surgery. RS included 112 surgical local resections (SLRs), 5 laparoscopic wedge resections (LAPs), 51 pylorus-preserving gastrectomies (PPGs), 38 proximal gastrectomies (PXGs), and 377 omentum-preserving modified radical gastrectomies (OPCs) Results: (1) There were few postoperative complaints after SLR, and 6 re-treatments (2 under-treatments and 4 metachronous cancers). The 5-year survival was 81/9%, and there was only one gastric cancer death. (2) All LAP patients are alive and healthy. (3) Remnant gastritis and esophagitis were rare after PPG, and the recovery of weightloss was good and rapid. Tc^{99 m} scintiscans, however, revealed bile juice regurgitation in 24% Two re-operations were performed for recurrence, but all patients are alive and cancer-free. (4) The 5-year survival for PXG was 84.2%, and there have been no gastric cancer deaths. (5) Ileus occurred less frequently after OPG than after gastrectomy with omentectomy, The 5-year survival after OPG was 79.4%, and there were no gastric cancer deaths. The postoperative survival of the treated patients was almost the same as for standard gastrectomy, and their postoperative QOL was found to be better than after radical surgery. In conclusion, these methods of rational surgery appear to be appropriate for improving postoperative QOL without loss of survival benefit.

Key words
early gastric cancer, rational surgery, epidemiology of Niigata prefecture

Reprint requests
Atsushi Nashimoto Divison of Surgery, Niigata Cancer Center Hospital
2-15-3 Kawagishicho, Niigata, 951-8566 JAPAN

Accepted
July 22, 1998

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