A History of Gastric Cancer Surgery and the Evidence for it

Abstract

Billroth succeeded in the first gastrectomy for cancer in 1881, and his apprentice Mikulicz systematized lymphadenectomy. The scope of gastrectomy and lymphadenectomy subsequently enlarged in the early 20^th century. In Japan, the Japanese Research Society for Gastric Cancer collected an enormous amount of clinicopathological data of gastric cancer patients, based on which surgeons developed systematic lymphadenectomy. In the West, on the other hand, a series of randomized, controlled trials (RCT) for breast cancer established an oncological concept that the primary role of lymphadenectomy was staging rather than treatment, which was applied to other organs. Various RCTs on gastric cancer surgery were conducted in Europe and Japan after the 1980s, and “D2 gastrectomy without pancreatosplenectomy by experienced hands” is now recommended for non-early gastric cancer. Evidence of survival benefit of adjuvant or neoadjuvant therapy started to be established in succession in the 21^st century, and surgeons are now expected to perform safe and sufficient gastrectomy while aware of their role in multidisciplinary therapy.