Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan;24(1):1-21.
doi: 10.1007/s10120-020-01042-y. Epub 2020 Feb 14.

Japanese gastric cancer treatment guidelines 2018 (5th edition)

Japanese Gastric Cancer Association

Japanese gastric cancer treatment guidelines 2018 (5th edition)

Japanese Gastric Cancer Association. Gastric Cancer. 2021 Jan.
No abstract available

PubMed Disclaimer

Conflict of interest statement

Dr. Baba reports grants and personal fees from Chugai, grants and personal fees from Ono, grants and personal fees from Takeda, grants and personal fees from Eli Lilly, grants and personal fees from Taiho, grants from Medi Science Planning, grants and personal fees from MSD, grants from Astellas, grants and personal fees from Merck Serono, grants and personal fees from Daiichi Sankyo, grants and personal fees from Bristol-Myers, grants and personal fees from Esai, grants and personal fees from Bayer, grants and personal fees from Yakult, personal fees from Sumitomo Dainippon Pharma, personal fees from Kyowa Kirin, personal fees from Sanofi, personal fees from Tsumura, outside the submitted work. Dr. Kodera reports grants and personal fees from Taiho Pharma, grants and personal fees from Chugai Pharma, grants and personal fees from Takeda, grants and personal fees from MSD, grants from Nihon Kayaku, grants and personal fees from Yakult Pharma, grants and personal fees from Lilly Japan, grants and personal fees from Ono Pharma, grants from Kaken Pharma, grants and personal fees from Johnson & Johnson, grants and personal fees from Covidien, grants from EA Pharma, grants from Novartis, grants from KCI, grants from Maruho, grants from Daiichi Sankyo, grants and personal fees from Otsuka, grants from Tsumura, grants from Sawai, grants from Bristol, and grants from Sanofi outside the submitted work. Dr. Sano reports personal fees from Taiho Pharma, personal fees from Chugai Pharma, personal fees from Ono Pharma, personal fees from Lilly Japan, and personal fees from Yakult Pharma outside the submitted work.

Figures

Fig. 1
Fig. 1
Algorithm of standard treatments. The T/N/M and Stage are used in conjunction with the Japanese Classification of Gastric Carcinoma 15th edition [1] and TNM classification 8th edition [2]
Fig. 2
Fig. 2
Lymph node dissection in total gastrectomy. Lymph node stations in blue need to be dissected in D1 dissection. In addition, lymph node stations in orange need to be dissected in D1+ dissection and lymph node stations in red as well in D2 dissection
Fig. 3
Fig. 3
Lymph node dissection in distal gastrectomy. Lymph node stations in blue need to be dissected in D1 dissection. In addition, lymph node stations in orange need to be dissected in D1+ dissection and lymph node stations in red as well in D2 dissection
Fig. 4
Fig. 4
Lymph node dissection in pylorus-preserving gastrectomy. Lymph node stations in blue need to be dissected in D1 dissection. In addition, lymph node stations in orange need to be dissected in D1+ dissection
Fig. 5
Fig. 5
Lymph node dissection in proximal gastrectomy. Lymph node stations in blue need to be dissected in D1 dissection. In addition, lymph node stations in orange need to be dissected in D1+ dissection
Fig. 6
Fig. 6
Algorithm of lymph node dissection for junctional carcinoma with diameter ≤ 4 cm. Difficulties are expected in accurately discriminating between lymph node station Nos. 19 and 20 and among lymph node station Nos. 110, 111 and 112. Thus, the lymph node around the hiatus and lower mediastinal lymph nodes are expected to be removed en bloc. Complete removal of lymph node station No. 3b is not mandatory when proximal gastrectomy is selected. 1) Clinical relevance of dissecting the upper mediastinal lymph nodes is unclear since the incidence of metastasis is low. 2) Cervical lymph nodes are infrequently dissected and clinical relevance of dissecting these nodes is unknown. However, it is noteworthy that there are long-term survivors among those with histologically confirmed metastases among the cervical nodes. 3) For the E=G category, lower mediastinal modes and hiatal nodes were rarely dissected, and the incidence of metastasis among those who underwent resection was low. 4) Cervical, upper mediastinal and middle mediastinal nodes are rarely dissected for this category, and data to discuss on the clinical relevance of dissecting these nodes are lacking
Fig. 7
Fig. 7
Algorithm showing curability decision and additional treatments for patients who underwent endoscopic resection
Fig. 8
Fig. 8
Recommended regimens for the first-, second- and third-line treatments. Only the “Recommended regimens” as defined in the text are included. These regimens are recommended for patients who are in sufficiently favorable general condition to be eligible in the clinical trials from which the evidence in support of these regimens were generated. Strengths of the evidence level for each regimen are shown in brackets
Fig. 9
Fig. 9
“Conditionally recommended regimens” shown in alphabetical order. Even when using the “Conditionally recommended regimens”, refer to Fig. 8 for the basic strategy and attempt to use drugs from all of the following six categories during the course of the treatment; fluoropyrimidines, platinum, taxanes, irinotecan, ramucirumab and nivolumab. However, it is important to note that continuation of any of the drugs cannot be recommended beyond progression
Fig. 10
Fig. 10
Postoperative follow-up for Stage I gastric cancer patients
Fig. 11
Fig. 11
Postoperative follow-up for Stage II–III gastric cancer patients
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Association Japanese Gastric Cancer. Japanese Classification of Gastric Carcinoma. 15. Tokyo: Kanehara Shuppan; 2017.
    1. Brierley JD, Gospodarowicz MK, Wittekind C, editors. TNM Classification of Malignant Tumours. 8. New Jersey: Wiley Blackwell; 2017.
    1. Kaminishi M, Yamaguchi H, Shimizu N, et al. Stomach-partitioning gastrojejunostomy for unresectable gastric carcinoma. Arch Surg. 1997;132:184–187. doi: 10.1001/archsurg.1997.01430260082018. - DOI - PubMed
    1. Fujitani K, Yang HK, Mizusawa J, et al. Gastrectomy plus chemotherapy versus hemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trial. Lancet Oncol. 2016;17:309–318. doi: 10.1016/S1470-2045(15)00553-7. - DOI - PubMed
    1. Sano T, Sasako M, Mizusawa J, et al. Stomach Cancer Study Group of the Japan Clinical Oncology Group: randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma. Ann Surg. 2017;265:277–283. doi: 10.1097/SLA.0000000000001814. - DOI - PubMed