Abstract
In the last 2 decades, there has been a striking improvement in Japan in the prognosis of gastric cancer. Much of the improvement is attributed to the increased early detection of the cancer and the standardization of prophylactic lymphadenectomy. However there are limitations to surgery. Here, an effective combined therapy has to be considered. Since the 1980s, the clinical values of prophylactic splenectomy in total gastrectomy has remained an open question. Limited operation for early gastric cancer and extensive en bloc resection for advanced cancer are recently advocated treatments. Although such approaches warrant further attention, it must be stressed that radicality, safety of surgery and the alleviation of symptoms for such patients play a critical part in determining the treatment of choice.
