https://link.springer.com/article/10.1007/s10120-016-0622-4
Preface to the English edition
This English edition was made based on the Japanese version published as a book in 2014. Our policy in compiling this edition was to attempt not to include new evidence that emerged since the publication of the Japanese version so as to maintain consistency of the two editions. However, for some particularly important issues, we provided additional comments and new references reflecting the new evidence.
Preface
Version 4 of the Japanese Gastric Cancer Treatment Guidelines was completed in May 2014, incorporating new evidence that includes those delivered as a quick bulletin in the website of the Japan Gastric Cancer Association after publication of the previous version. It remains largely conformed to the textbook style, but a new section consisting of clinical questions and answers (Q&A) was added to address some important clinical issues for which hard evidence is unavailable.
To compile this version, the guideline committee nominated several working groups, each assigned to make relevant contributions to unsolved issues on the following topics: (1) surgery and lymphadenectomy for junctional cancer, (2) clinical pathway, (3) follow-up after curative surgery, (4) treatment of technically resectable metastatic cancer, (5) risk calculation for surgical intervention and (6) treatment of cancer of the gastric remnant. Of these, tentative consensuses were reached on the first three topics that were included as new sections in the text, whereas further discussion was deemed necessary for the last two topics. The clinical importance of the fourth topic and lack of hard evidence related to that topic prompted the committee to establish a Q and A section to provide tentative best answers to important clinical questions on technically resectable metastatic cancer.
Major points of revision in the current version are listed below:
- 1.The section on types and definitions of gastric surgery has been revised.
- 2.An algorithm showing the tentative standard of the extent of lymphadenectomy that can be recommended for junctional cancer less than 4 cm in diameter has been presented.
- 3.Laparoscopic distal gastrectomy for clinical stage I cancer was upgraded from an investigational treatment to an option in general practice.
- 4.Chemotherapeutic regimens were classified into three recommendation categories based on the level of evidence and consensus among the committee members.
- 5.A revision was made to the definition of curative resection among tumors of expanded indication for endoscopic resection. Additional descriptions were given on the biopsy-derived scar and component of “muc” in the submucosa of the endoscopy-resected specimen.
- 6.Clinical questions were raised on treatment strategy for technically resectable metastatic cancer and chemotherapy for patients for whom eviOpen image in new windowdence-based standard treatment may not be applicable, and the tentative but best possible answers were provided.
- 7.Exemplary samples of the clinical pathway for management of patients who underwent gastrectomy and the follow-up schedule after surgery for gastric cancer were presented.
The description of tumor status (T/N/M and stage) in this guideline remains to be based on the third English edition of the Japanese Classification of Gastric Carcinoma [1], which is identical to that in the 7th edition of the International Union Against Cancer (UICC)/TNM.
Treatments
Algorithm of standard treatments to be recommended in clinical practice
Investigational treatments
The following treatments show promise but are as yet to be established as the standard. They should be prospectively evaluated in appropriate clinical research settings. Patient consent for investigational treatments should be sought and the rationale behind them given.
The following constitute investigational treatments:
- Endoscopic submucosal dissection under the expanded criteria [see “Tumors indicated for endoscopic resection as an investigational treatment (expanded indication)”].
- Laparoscopic surgery for advanced cancer and those in need of total gastrectomy.
- Local tumor resection.
- Neoadjuvant chemotherapy.
- Adjuvant chemotherapy using agents other than S-1.
- Neoadjuvant chemoradiotherapy.
- Adjuvant chemoradiotherapy.
