Paradigm Shift and Future Perspectives in Gastric Cancer Surgery—Considerations for Sustainability of Surgical Treatment in Japan—

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  • KODERA Yasuhiro
    Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine

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  • 胃癌外科のパラダイムシフトと今後の展望―持続可能な外科診療のために―
  • イガン ゲカ ノ パラダイムシフト ト コンゴ ノ テンボウ : ジゾク カノウ ナ ゲカ シンリョウ ノ タメニ

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Abstract

<p>Patients with gastric cancer, necessitating surgery, have decreased due to the reduced age-standardized incidence rates and expanded indications for endoscopic resection. The increased rate of early-onset gastric cancer in the West suggested that gastric cancer has become less rare. The effectiveness of radical gastrectomy as a treatment option for gastric cancer has almost plateaued. Further improvement in the long-term outcome will likely be influenced by the emergence of new drugs and the appropriate timing of their administration. The radical gastrectomy technique has become less complex because the survival benefit of various procedures, that had been integrated as components of D2 dissection, were denied by various randomized trials that looked at survival benefit. In modern surgery, a complete resection without postoperative complications is achieved via a minimally invasive approach. In addition, robotic surgery increases the sustainability of surgery in countries like Japan, which suffer from an insufficient number of surgeons. Meanwhile, postgastrectomy symptoms, measured by QOL scales, remain problematic despite decades of research, exploring the various types of reconstruction.</p>

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