Changing state of gastric cancer in Japan. Histologic perspective of the past 76 years.

One thousand thirty-eight patients with primary gastric cancer treated operatively during the past 20 year period were described. The results were compared with those in the period from 1904 to 1927 to illustrate the changes which have taken place in diagnosis and treatment of gastric cancer during the past 76 years in Japan. All data was from the Department of Surgery I, Kyushu University. After half a century of status quo, improvement started around the mid 1960s, which coincided with the introduction of newer, improved procedures for diagnosis of gastric cancer, such as double contrast roentgenography of the stomach, endoscopic observation, and biopsy of suspected lesions. A mass population survey for the presence of gastric cancer in persons of approximately 40 years of age has led to an ever increasing number of early gastric cancer cases. The emergence of early simulating advanced cancer with relatively good prognosis and the changing state of the Borrmann type of advanced cancer have contributed to the improvement. The present study demonstrates once again the importance of early detection of gastric cancer for an increased chance of cure, since conventional lymph node dissection seems to be unnecessary, and of even earlier detection of gastric tumors of less than 1 cm in diameter for the best chance of complete cure in the latter.