New Technologies in Gastric Cancer Surgery: Computer system to make operation plan and intraoperative staining of regional lymph nodes for complete dissection

Abstract

As the death rate from gastric cancer in Japan was extremely high, establishment of a control method was one of the most urgent social demands. The National Cancer Center was established in 1962 and its major function was to satisfy this demand. Early detection of gastric cancer is essential for successful surgical treatment and the centre has improved and disseminated many new diagnostic methods for gastric cancer such as double contrast X-ray examination, gastro-camera and fibrescopes, camera and biopsy, dye staining techniques, ultrasound examination, etc. The surgical treatment has also become more extensive with systemic lymph node dissection, an expansion of the earlier indication for total gastrectomy with a combined resection of adjacent organs, introduction of thoraco-abdominal incision, pancreas preserving total gastrectomy, etc. Treatment results have improved as a result of using these techniques. The number of cases that are resectable has increased from 84% to 97% in the 25 year period and the percentage of curative resections from 55 to 77% (Figure 1). Cumulative 5-year survival rates for all primary gastric cancer patients have risen from 41% to 69% and from 85% to 93% for patients with stage I disease, 57% to 83% in stage II, 33% to 50% in stage III and from 14% to 39% in stage IV (Figure 2). Despite the surgery becoming more extensive over this period there has been a fall in the operative mortality from 3.0% to 0.6% (Figure 3).