The 2010 Japanese Gastric Cancer Treatment Guidelines provide a comprehensive overview of standard and investigational treatments for gastric cancer. The guidelines are based on the 3rd English edition of the Japanese Classification of Gastric Carcinoma and align with the 7th edition of the International Union Against Cancer (UICC)/TNM classification. - **Standard Treatments**: Algorithm for clinical practice. - **Investigational Treatments**: Treatments under evaluation, such as endoscopic submucosal dissection under expanded criteria, should be prospectively studied and patient consent obtained. - **Curative Surgery**: Standard gastrectomy involves resection of at least two-thirds of the stomach with D2 lymph node dissection. - **Non-standard Gastrectomy**: Altered extent of resection based on tumor characteristics. - **Palliative Surgery**: Recommended for stage IV gastric cancer to relieve symptoms. - **Reduction Surgery**: Investigational for advanced gastric cancer without urgent symptoms. - **Total Gastrectomy**: Resection of the entire stomach. - **Distal Gastrectomy**: Resection of the distal part of the stomach. - **Pylorus-Preserving Gastrectomy (PPG)**: Resection of the distal stomach while preserving the pylorus. - **Proximal Gastrectomy**: Resection of the proximal part of the stomach. - **D1**: Lymphadenectomy of nodes 1-7. - **D2**: Lymphadenectomy of nodes 1-11 and 12. - **D2+**: Extended lymphadenectomy beyond D2. - **Vagal Nerve Preservation**: Important for maintaining postoperative quality of life. - **Omentectomy**: Removal of the greater omentum for T3 or deeper tumors. - **Buresectomy**: Removal of the inner peritoneal surface of the omentum for tumors penetrating the serosa. - **Combined Resection**: Resection of adjacent organs for R0 resection. - **Endoscopic Mucosal Resection (EMR)**: For T1a tumors ≤2 cm without ulcerative findings. - **Endoscopic Submucosal Dissection (ESD)**: For T1a tumors >2 cm or T1b tumors ≤3 cm. - **Indications for Endoscopic Resection**: T1a tumors with specific characteristics. - **Chemotherapy**: Recommended for unresectable or recurrent gastric cancer to delay symptoms and prolong survival. - **Adjuvant Chemotherapy**: S-1 is recommended for patients with pathological stage II, IIIA, or IIIB gastric cancer after R0 gastrectomy with D2 or greater lymphadenectomy. - **Laparoscopic Gastrectomy**: Increasing use but lacks strong evidence for standardization. - **Local Tumor Resection**: Limited to poor-risk patients due to expanded endoscopic resection indications. -The 2010 Japanese Gastric Cancer Treatment Guidelines provide a comprehensive overview of standard and investigational treatments for gastric cancer. The guidelines are based on the 3rd English edition of the Japanese Classification of Gastric Carcinoma and align with the 7th edition of the International Union Against Cancer (UICC)/TNM classification. - **Standard Treatments**: Algorithm for clinical practice. - **Investigational Treatments**: Treatments under evaluation, such as endoscopic submucosal dissection under expanded criteria, should be prospectively studied and patient consent obtained. - **Curative Surgery**: Standard gastrectomy involves resection of at least two-thirds of the stomach with D2 lymph node dissection. - **Non-standard Gastrectomy**: Altered extent of resection based on tumor characteristics. - **Palliative Surgery**: Recommended for stage IV gastric cancer to relieve symptoms. - **Reduction Surgery**: Investigational for advanced gastric cancer without urgent symptoms. - **Total Gastrectomy**: Resection of the entire stomach. - **Distal Gastrectomy**: Resection of the distal part of the stomach. - **Pylorus-Preserving Gastrectomy (PPG)**: Resection of the distal stomach while preserving the pylorus. - **Proximal Gastrectomy**: Resection of the proximal part of the stomach. - **D1**: Lymphadenectomy of nodes 1-7. - **D2**: Lymphadenectomy of nodes 1-11 and 12. - **D2+**: Extended lymphadenectomy beyond D2. - **Vagal Nerve Preservation**: Important for maintaining postoperative quality of life. - **Omentectomy**: Removal of the greater omentum for T3 or deeper tumors. - **Buresectomy**: Removal of the inner peritoneal surface of the omentum for tumors penetrating the serosa. - **Combined Resection**: Resection of adjacent organs for R0 resection. - **Endoscopic Mucosal Resection (EMR)**: For T1a tumors ≤2 cm without ulcerative findings. - **Endoscopic Submucosal Dissection (ESD)**: For T1a tumors >2 cm or T1b tumors ≤3 cm. - **Indications for Endoscopic Resection**: T1a tumors with specific characteristics. - **Chemotherapy**: Recommended for unresectable or recurrent gastric cancer to delay symptoms and prolong survival. - **Adjuvant Chemotherapy**: S-1 is recommended for patients with pathological stage II, IIIA, or IIIB gastric cancer after R0 gastrectomy with D2 or greater lymphadenectomy. - **Laparoscopic Gastrectomy**: Increasing use but lacks strong evidence for standardization. - **Local Tumor Resection**: Limited to poor-risk patients due to expanded endoscopic resection indications. -