Cancer Gastrico

Gastric Cancer
DOI 10.1007/s10120-011-0042-4

SPECIAL ARTICLE

Japanese gastric cancer treatment guidelines 2010 (ver. 3)
Japanese Gastric Cancer Association

Ó The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2011

The description of tumor status (T/N/M and stage) in this
guideline is based on the 3rd English edition of the JapaneseClassification of Gastric Carcinoma [1] which is
identical to that in the 7th edition of the International
Union Against Cancer (UICC)/TNM.
1 Treatments
1.1 Algorithm of standard treatments
to be recommended in clinical practice
The algorithm is shown on the following page.
1.2 Investigational treatments
The following treatments show promise but are as yet to be
established as standard. They should beprospectively
evaluated in appropriate clinical research settings. Patient
consent for investigational treatments should be sought and
the rationale behind them given (Refer to the Sect. 6
‘‘Commentary on investigational treatments’’ for details).
The following constitute investigational treatments:
– Endoscopic submucosal dissection under expanded
criteria
The online version of theprefatory article referred to in this article
can be found under doi:10.1007/s10120-011-0040-6.
English edition editors: Takeshi Sano (&), Yasuhiro Kodera.
e-mail: takeshi.sano@jfcr.or.jp

–
–
–
–
–
–
–

Laparoscopic gastrectomy
Local tumor resection
Neoadjuvant chemotherapy
Adjuvant chemotherapy using agents other than S-1
Neoadjuvant chemoradiotherapy
Adjuvant chemoradiotherapyDebulking surgery.

2 Surgery
2.1 Types and definitions of gastric surgery
2.1.1 Curative surgery
2.1.1.1 Standard gastrectomy Standard gastrectomy is the
principal surgical procedure performed with curative
intent. It involves resection of at least two-thirds of the
stomach with a D2 lymph node dissection.
2.1.1.2 Non-standard gastrectomy In non-standard gastrectomy, the extent of gastricresection and/or lymphadenectomy is altered according to the tumor characteristics.
2.1.1.2.1 Modified surgery The extent of gastric resection and/or lymphadenectomy is reduced compared to
standard surgery.
2.1.1.2.2 Extended surgery (1) Gastrectomy with combined resection of adjacent involved organs. (2) Gastrectomy with extended lymphadenectomy exceeding D2.
2.1.2 Non-curative surgery

JapaneseGastric Cancer Association (&)
Association Office, First Department of Surgery,
Kyoto Prefectural University of Medicine, Kawaramachi,
Kamigyo-ku, Kyoto 602-0841, Japan
e-mail: jgca@koto.kpu-m.ac.jp

2.1.2.1 Palliative surgery Urgent presentations with
symptoms of bleeding or obstruction may develop in
patients with advanced gastric cancer with unresectable

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Japanese GastricCancer Association

Gastric carcinoma

M0

cT1

M1

cT2/T3/T4a

cN0

cT4b

cN+

cT1a (M)

cT1b (SM)

Differentiated,
≤ 2 cm, UL (-)

Differentiated,
≤1.5 cm

Yes

Endoscopic
resection

No

Yes

Gastrectomy,
D1

No

Standard
gastrectomy,
D2

Gastrectomy,
D1+

Gastrectomy,
combined resection,
D2

Chemotherapy,
radiotherapy,
palliative surgery,palliative care
medicine

After surgery
p-Stage I

p-Stage II, III
except pT1 and pT3(SS)pN0

Stage IV

Observation

Adjuvant
chemotherapy

Chemotherapy,
best supportive care

metastases. Palliative surgery to relieve symptoms is
recommended as an option for stage IV gastric cancer,
provided that the patient is fit. Palliative gastrectomy or
gastrojejunostomy is selected dependingon the resectability of the primary tumor and/or surgical risks. Stomachpartitioning gastrojejunostomy has been reported to result
in superior function compared to simple gastrojejunostomy
[2].
2.1.2.2 Reduction surgery The role of gastrectomy is
unclear in patients with advanced gastric cancer with
unresectable metastatic disease in the absence of urgent
symptoms such as bleeding or...