Extended Lymph Node Dissection for Advanced Gastric Cancer and Endoscopic Surgery for Early Gastric Cancer

Most studies from western countries have not seemed to show a demonstrably increased survival rate with acceptable postoperative morbidity in gastric cancer patients undergoing radical lymphadenectomy [1–3]. The 5-year survival rate of gastric cancer was approximately 20% in most Japanese institutions during the 1950s. According to the national registry of stomach cancer in Japan, the 5-year survival rate of curatively resected gastric cancer improved up to 75% in 1981 [4]. Such remarkable improvement is attributed largely to the system of detecting early gastric cancer by screening tests as well as to the establishment of adjuvant chemotherapy. In more recent studies in Japan, the incidence of early gastric cancer was approximately 40% [5, 6] and this certainly boosted the overall survival curves in gastric cancer patients. In other words, investigation of survival rates according to accurate staging is needed.