"The Japanese Gastric Cancer Society recommends Cconservative surgery is performed for patients with early gastric cancer, according to the guideline proposed from Japanese Gastric Cancer Society. However, Tthere are many kinds of operations conservative surgical options, such as including ordinary open surgery, laparoscopic-assisted gastrectomy, laparoscopic intragastric surgery, pyrolus pylorus-preserving gastrectomy, and hand-assisted laparoscopic surgery. Indications of the operations are various, but it is necessary to have standard indication for each procedure Guidelines for choosing among these options have yet to be established.
Standard operation fFor advanced gastric cancer, the standard operation in Japan is D2 gastrectomydissection. However, this procedure has a high postoperative mortality and morbidity, which has led some Ssurgeons in Eastern world believed that to favor D1 dissection +plus alpha or D1 dissection +plus adjuvant radio-chemotherapy are the standard treatments, because of high incidence of mortality and morbidity after D2 dissection. [please check that intended meaning is preserved]
For patients with nodal involvement
In Japan, D4 dissection has been performedused in Japan for patients with nodal involvement, and the validity efficacy of D4 dissection is now studied by the subject of two randomized trials.
For T4 tumors,
Ccombined resection [do you mean gastro-pancreato-splenectomy?] for T4 tumor is believed to beconsidered mandatory. However, the validity use of pancreato-splenectomy to yield a complete clearance of the No. 10 or and No. 11 lymph node stations is in controversial, because of the high postoperative incidence of the postoperative development ofpancreatic fistula, anastomotic insufficiency, and abscess. Though omentectomy is routinely performed, Tthere was are no prospective studies y to confirming the effect of omentectomyits efficacy. Patients with aAdvanced gastric cancer showing a with serosal invasion- diameter less than 2.5 cm in diameter has ve less risk of peritoneal recurrence, so . Iit may be valuable to perform undertake a randomized controlled [redundant - you have stated the control group] study consisting of comparing gastrectomy plus omentectomy to omentum-preserving gastrectomy and gastrectomy with omentectomy.
Prognosis of In patients with peritoneal dissemination, was improved by intraperitoneal chomo hyporthormia [? chemo-hyperthermia - please confirm spelling] and plus peritonectomy has improved prognoses, and prospective studies should be done undertaken to compare the effects of this treatment with systemic chemotherapy and regional chemotherapy combined with peritonectomy. [please check that intended meaning is preserved] Furthermore, The effect s of neoadjuvant chemotherapy with on cytoreduction with R0 resection should also be confirmed by prospectively studie sd."