Differences between Japan and the west in treatment strategy for gastrointestinal cancer--gastric cancer

Diagnosis, staging, and treatment strategies for gastric cancer were reviewed with regard to differences between Japan and the West. In Japan, detection of early gastric cancer is common due to mass screening and widespread use of endoscopy. Treatment options for gastric cancer vary from endoscopic mucosal resection to the super-extended lymphadenectomy. Correct selection from the available options requires meticulous staging including endoscopy with indigocarmine spray, double contrast barium meal study, endoscopic ultrasonography, CT, abdominal ultrasound, and sometimes barium enema to detect possible peritoneal seeding. Western gastric cancer patients are, on average, 10 years older, more obese, have more cardiopulmonary disease, and more advanced tumors than Japanese patients. Because of the high proportion of patients with extensive disease at presentation in the West, laparoscopic staging is frequently used to avoid non-curative surgery. In Japan, D2 lymphadenectomy is the standard, and now a more extended surgery (D4) is being evaluated in a randomized controlled study, while D2 lymphadenectomy has been reported to be associated with high morbidity and mortality in European studies. Adjuvant chemotherapy is more commonly used in Japan, mostly with oral fluorouracil. However, no regimen has been shown effective in the adjuvant setting in either Japanese and Western studies.