The Japanese Gastric Cancer Association (JGCA) started a new nationwide gastric cancer registration in 2008.
Methods
From 208 participating hospitals, 53 items including surgical procedures, pathological diagnosis, and survival outcomes of 13,626 patients with primary gastric cancer treated in 2002 were collected retrospectively. Data were entered into the JGCA database according to the JGCA classification (13th edition) and UICC TNM classification (5th edition) using an electronic data collecting system. Finally, data of 13,002 patients who underwent laparotomy were analyzed.
Results
The 5-year follow-up rate was 83.3 %. The direct death rate was 0.48 %. UICC 5-year survival rates (5YEARSs)/JGCA 5YEARSs were 92.2 %/92.3 % for stage IA, 85.3 %/84.7 % for stage IB, 72.1 %/70.0 % for stage II, 52.8 %/46.8 % for stage IIIA, 31.0 %/28.8 % for stage IIIB, and 14.9 %/15.3 % for stage IV, respectively. The proportion of patients more than 80 years old was 7.8 %, and their 5YEARS was 51.6 %. Postoperative outcome of the patients with primary gastric carcinoma in Japan have apparently improved in advanced cases and among the aged population when compared with the archival data. Further efforts to improve the follow-up rate are needed.
Conclusions
Postoperative outcome of the patients with primary gastric carcinoma in Japan have apparently improved in advanced cases and among the aged population when compared with the archival data. Further efforts to improve the follow-up rate are needed.
Hinweise
All the authors are members of the Registration Committee of the Japanese Gastric Cancer Association.
Introduction
The registration committee of the Japanese Gastric Cancer Association (JGCA) started a new registration program in 2008 after a 10-year blank period, and we reported the 5-year follow-up data of the patients treated in 2001 [1]. The registration has been continuing, and here we report the results of those treated in 2002.
Materials and methods
Leading hospitals in Japan voluntarily downloaded and fulfilled the database provided by the JGCA and sent the anonymized data to the JGCA data center. The collected data were analyzed according to the previously reported methods [1].
Anzeige
Results
Data of 14,394 patients were collected from 208 hospitals; 126 (60.6 %) hospitals participated in both years, but 82 hospitals were new, which was a 10 % increase as compared to the previous year (13,067 patients from 187 hospitals). The geographic distribution of the registered patients among the 47 prefectures is illustrated in Fig. 1. In Tokyo, 2,332 patients per year were registered, followed by 1,464 in Osaka. Four other prefectures registered more than 500 patients. On the other hand, the number of registered patients was fewer than 100 in 10 prefectures, and there were no registered patients in 2 prefectures.
Fig. 1
Geographic distribution of registered patients by prefecture
×
Patients with remnant stomach cancer, non-epithelial malignant tumor, and gastric cancer combined with malignant tumor of other organs were excluded. Patients who were treated by endoscopic mucosal resection were also excluded. Data of 768 patients lacked essential items. Consequently, data of the remaining 13,002 patients were used for the final analysis.
The results are shown in Tables 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, and 28. Data given for each category of patients are: total number of patients, survival rates by year, standard error of 5YEARS, the number of direct death within 30 postoperative days, the number of patients lost to follow-up within 5 years, the number of 5-year survivors, and main cause of death, such as local and/or lymph node metastasis, peritoneal metastasis, liver metastasis, distant metastasis, recurrence at unknown site, other cancer, and other disease. Figures 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, and 17 provide cumulative survival curves of patients stratified by essential categories.
Table 1
Primary cancer
Categories
No. of patients
Direct death
Lost f.u.
1 years (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
Primary cancer
13626
89
2233
88.1
79.6
74.5
71.2
68.9
0.4
7436
454
1483
388
243
322
167
567
333
lost f.u. lost to follow-up, years(%) years of cumulative survival rate, SE standard error, rec recurrence, peritoneal peritoneal recurrence, R recurrence of unknown site
Table 2
Resected cases and unresected cases and other surgeries
Categories
No. of patients
Direct death
Lost f.u.
1 year (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
Resected cases
13002
63
2173
89.8
81.6
76.5
73.1
70.7
0.4
7286
410
1283
357
215
278
158
539
303
Unresected cases
355
21
25
25.7
7.3
2.9
1.9
1.5
0.7
4
37
183
24
24
32
2
12
12
Table 3
Sex (resected cases)
Categories
No. of
patients
Direct death
Lost f.u.
1 years (%)
2 years
(%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
Male
8887
43
1464
89.7
81.4
76.1
72.5
70.0
0.5
4939
292
805
280
136
203
133
425
210
Female
4115
20
709
90.1
82.2
77.4
74.3
72.3
0.7
2347
118
478
77
79
75
25
114
93
Table 4
Age (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 year (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
<39
297
0
50
93.0
83.2
82.1
80.2
79.4
2.4
190
5
36
1
4
4
0
1
6
40–59
3622
10
581
93.4
86.7
83.2
80.3
78.8
0.7
2316
78
327
67
61
64
28
42
58
60–79
8075
40
1279
89.1
80.5
74.8
71.4
68.9
0.5
4450
282
798
255
142
180
110
387
192
>80
1008
13
263
81.6
71.6
63.9
57.0
51.4
1.8
330
45
122
34
8
30
20
109
47
Table 5
Tumor location (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 year (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
U
2681
18
434
87.3
77.5
71.1
67.1
64.3
1.0
1356
104
267
99
76
68
39
150
88
M
5182
8
881
93.6
88.4
84.4
81.7
79.7
0.6
3322
102
339
101
62
72
48
153
102
L
4249
28
766
90.3
81.8
76.8
73.2
70.8
0.7
2338
159
380
124
46
90
59
200
87
Whole
584
8
62
63.7
37.9
28.7
22.9
19.3
1.7
88
37
256
20
24
45
5
22
25
U upper third, M middle third, L lower third
Table 6
Macroscopic type (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 year (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
Type0
6869
13
1294
98.1
96.1
94.0
92.1
90.2
0.4
4959
40
69
31
22
24
105
244
81
Type1
363
0
62
89.1
78.6
71.1
68.2
65.5
2.6
187
12
22
24
9
9
5
20
13
Type2
1717
21
291
87.0
75.8
68.1
63.0
60.4
1.2
798
86
147
118
49
61
20
105
42
Type3
2575
17
364
79.6
63.3
54.3
49.1
46.0
1.0
914
181
532
158
79
102
22
115
108
Type4
923
9
86
63.7
37.9
28.2
21.5
17.7
1.3
127
55
450
12
39
72
2
36
44
Type5
339
2
43
83.9
74.5
67.0
63.7
60.6
2.8
171
16
51
9
12
8
3
13
13
Table 7
Histological type (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 years (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
Papillary adenocarcinoma (pap)
464
6
86
88.2
78.8
70.7
66.7
64.3
2.4
227
15
30
36
7
13
10
26
14
tub 1
2846
9
542
96.2
92.4
88.3
85.9
83.6
0.7
1877
32
71
47
14
29
51
146
37
tub 2
3458
18
585
91.0
82.8
77.0
73.3
70.8
0.8
1936
120
259
131
64
63
48
169
83
por 1
1746
10
301
85.0
75.1
70.1
66.3
64.4
1.2
867
81
192
72
41
63
13
69
47
por 2
2449
15
309
83.0
70.2
64.2
59.6
57.0
1.0
1148
120
530
43
63
80
16
81
59
Signet-ring cell carcinoma (sig)
1581
5
279
94.2
89.0
85.8
83.6
81.5
1.0
1030
18
127
4
17
18
16
30
42
Mucinous adenocarcinoma (muc)
259
0
34
83.7
68.6
61.9
59.3
55.2
3.2
116
14
53
4
5
6
2
11
14
Adenosquamous carcinoma
17
0
0
52.9
29.4
23.5
23.5
23.5
10.3
4
2
1
4
1
0
1
1
3
Squamous cell carcinoma
6
0
0
100.0
66.7
50.0
50.0
50.0
20.4
3
0
0
2
0
1
0
0
0
Miscellaneous carcinoma
75
0
18
77.9
69.0
64.2
62.4
58.8
6.1
29
4
6
11
1
1
0
2
3
tub 1 tubular adenocarcinoma, well-differentiated type; tub 2 tubular adenocarcinoma, moderately differentiated type; por 1 poorly differentiated adenocarcinoma, solid type, por 2, poorly differentiated adenocarcinoma, non-solid type
Table 8
Histological findings (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 year (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
Differentiated type
6768
33
1213
93.0
86.6
81.3
78.1
75.7
0.5
4040
167
360
214
85
105
109
341
134
Undifferentiated type
6035
30
923
86.5
76.5
71.5
67.8
65.5
0.6
3161
233
902
123
126
167
47
191
162
Other type
98
0
18
74.9
61.5
55.7
54.4
51.8
5.3
36
6
7
17
2
2
1
3
6
Table 9
Lymphatic invasion(ly) (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 year (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
ly0
5744
10
1089
97.8
95.3
93.3
91.3
89.6
0.4
4108
22
108
21
21
23
80
202
70
ly1
3156
16
524
92.6
84.9
79.7
75.4
72.7
0.8
1833
67
278
88
42
58
38
148
80
ly2
2208
14
321
83.2
69.1
59.8
54.9
51.3
1.1
891
135
370
142
74
87
25
103
60
ly3
1769
23
217
67.1
46.1
36.4
31.2
28.6
1.1
387
183
516
105
77
103
12
78
91
Table 10
Venous invasion(v) (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 years (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
v0
8027
22
1456
95.8
91.6
88.3
85.8
83.4
0.4
5344
105
384
68
57
69
107
308
129
v1
2800
21
405
85.1
72.9
65.1
60.3
57.6
1.0
1284
146
446
110
81
84
32
121
91
v2
1347
11
183
75.5
57.8
48.3
42.9
40.8
1.4
425
100
291
97
44
75
13
68
51
v3
676
9
104
66.1
45.5
38.2
33.3
31.5
1.9
151
54
145
80
31
44
3
34
30
Table 11
Depth of invasion (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 year (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
pT1(M)
3293
9
689
98.8
97.8
96.4
94.9
93.5
0.5
2410
3
7
3
2
4
40
109
26
pT1(SM)
3110
6
550
98.0
95.8
93.5
91.7
89.7
0.6
2268
17
12
17
13
9
51
129
44
pT2(MP)
1341
4
252
95.8
91.5
87.2
84.8
82.1
1.1
869
25
31
27
16
13
17
62
29
pT2(SS)
2115
14
306
87.8
76.0
67.9
62.5
59.1
1.1
996
110
236
128
73
69
29
104
64
pT3(SE)
2567
26
301
72.5
51.0
40.3
33.6
30.3
1.0
614
192
839
153
94
138
14
109
113
pT4(SI)
458
4
52
57.7
34.6
26.3
21.9
20.6
2.0
68
47
154
28
17
42
4
21
25
Table 12
pT classification (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 year (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
pT1
6403
15
1239
98.4
96.9
95.0
93.3
91.7
0.4
4678
20
19
20
15
13
91
238
70
pT2
3456
18
558
90.9
82.0
75.3
71.1
67.9
0.8
1865
135
267
155
89
82
46
166
93
pT3
2567
26
301
72.5
51.0
40.3
33.6
30.3
1.0
614
192
839
153
94
138
14
109
113
pT4
458
4
52
57.7
34.6
26.3
21.9
20.6
2.0
68
47
154
28
17
42
4
21
25
Table 13
Lymph node metastasis (resected cases)
categories
No. of patients
Direct death
Lost f.u.
1 yearr (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
pN0
7603
20
1482
97.6
95.3
92.9
90.9
88.9
0.4
5350
29
132
52
21
34
107
303
93
pN1
2619
17
374
86.3
73.9
66.6
61.4
58.9
1.0
1240
115
402
124
59
81
28
124
72
pN2
2032
15
246
76.4
56.0
44.5
38.1
34.6
1.1
547
172
542
132
88
114
15
79
97
pN3
522
9
41
54.9
30.1
20.3
16.5
14.3
1.6
61
86
158
36
43
41
3
22
31
Table 14
Peritoneal cytology (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 year (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec
Distant meta.
R
Other cancer
Other disease
Unknown
CY0
5075
16
761
89.9
80.0
73.2
68.6
65.6
0.7
2675
229
576
200
117
112
60
199
146
CY1
761
16
71
52.2
26.1
18.3
15.0
12.3
1.3
72
45
386
28
36
52
2
33
36
Table 15
Peritoneal metastasis (P) (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 year(%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
fP0
12004
47
2082
92.3
85.2
80.3
77.0
74.5
0.4
7087
349
862
308
184
218
154
503
257
fP1
762
15
62
48.9
23.3
13.9
9.9
8.3
1.1
49
48
402
44
28
56
4
31
38
Table 16
Liver metastasis (H) (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 year (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
fH0
12441
57
2114
91.0
83.1
78.0
74.6
72.2
0.4
7114
386
1197
229
200
247
156
517
281
fH1
326
6
34
39.8
22.3
15.5
12.7
11.4
1.9
23
10
63
122
12
28
0
17
17
Table 17
Distant metastasis including peritoneal and liver metastasis (M) (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 year (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec
Distant meta.
R
Other cancer
Other disease
Unknown
fM0
12530
56
2128
90.4
82.5
77.5
74.1
71.7
0.4
7104
376
1186
322
185
262
155
518
294
fM1
216
6
15
53.2
29.5
18.1
13.5
12.4
2.4
22
21
73
28
26
15
1
11
4
Table 18
Japanese stage (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 year (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
StageIA
5640
14
1113
98.5
97.1
95.4
93.8
92.2
0.4
4126
11
11
10
4
11
86
215
53
StageIB
1822
5
364
97.2
94.4
90.8
88.1
85.3
0.9
1216
14
41
25
15
12
27
79
29
StageII
1424
3
220
95.0
86.5
80.2
75.5
72.1
1.2
834
50
100
43
30
30
15
69
33
StageIIIA
1178
6
159
88.6
74.0
63.1
56.1
52.8
1.5
501
81
199
55
30
40
14
56
43
StageIIIB
678
4
85
82.1
58.0
43.8
34.9
31.0
1.9
161
61
205
38
31
31
5
32
29
StageIV
1902
30
180
55.6
31.0
21.7
17.4
14.9
0.9
218
180
708
180
101
149
8
80
98
Table 19
Japanese stage (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 year (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
StageI
7462
19
1477
98.2
96.4
94.3
92.4
90.5
0.4
5342
25
52
35
19
23
113
294
82
StageII
1424
3
220
95.0
86.5
80.2
75.5
72.1
1.2
834
50
100
43
30
30
15
69
33
StageIII
1856
10
244
86.2
68.2
56.1
48.4
44.9
1.2
662
142
404
93
61
71
19
88
72
StageIV
1902
30
180
55.6
31.0
21.7
17.4
14.9
0.9
218
180
708
180
101
149
8
80
98
Table 20
TNM stage (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 year (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
Stage IA
5564
15
1111
98.2
97.1
95.5
93.9
92.3
0.4
4062
10
9
9
4
11
84
210
54
Stage IB
1950
5
385
97.0
93.8
89.9
87.5
84.7
0.9
1294
17
49
25
15
20
28
84
33
Stage II
1614
5
261
94.0
85.4
78.4
73.3
70.0
1.2
903
62
125
64
35
34
14
80
36
Stage IIIA
1048
9
133
86.1
68.4
58.2
50.6
46.8
1.6
399
75
204
44
33
37
15
55
53
Stage IIIB
477
1
58
79.6
55.6
41.9
32.2
28.8
2.2
107
45
166
19
18
28
4
17
15
Stage IV
1924
27
184
57.3
32.8
22.4
17.9
15.2
0.9
223
180
704
189
107
142
12
83
100
Table 21
TNM stage (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 year (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
StageI
7514
20
1496
98.1
96.2
94.1
92.2
90.3
0.4
5356
27
58
34
19
31
112
294
87
StageII
1614
5
261
94.0
85.4
78.4
73.3
70.0
1.2
903
62
125
64
35
34
14
80
36
StageIII
1525
10
191
84.1
64.4
53.2
44.9
41.2
1.3
506
120
370
63
51
65
19
72
68
StageIV
1924
27
184
57.3
32.8
22.4
17.9
15.2
0.9
223
180
704
189
107
142
12
83
100
Table 22
Surgical approach (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 year (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
Laparotomy
12166
59
2021
89.6
81.2
76.0
72.4
69.9
0.4
6745
391
1238
346
204
273
147
514
287
Thoracolaparotomy
152
2
13
70.7
52.0
41.4
38.5
35.4
4.0
45
14
35
6
10
5
3
12
9
Laparoscopic
658
2
136
97.7
96.4
95.0
94.4
93.3
1.0
481
4
6
4
0
0
8
13
6
Others
6
0
2
80.0
60.0
60.0
60.0
60.0
21.9
2
1
0
0
0
0
0
0
1
Table 23
Surgical procedures (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 year (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
Distal gastrectomy
7743
32
1405
93.1
86.9
82.6
79.9
77.7
0.5
4742
197
515
179
72
124
83
283
143
Total gastrectomy
3966
25
548
81.2
67.5
60.1
54.9
51.9
0.8
1635
207
752
164
138
145
45
194
138
Proximal gastrectomy
523
2
111
94.8
91.3
88.3
86.5
85.1
1.6
341
5
12
9
2
4
7
22
10
Pylorus-preserving gastrectomy
397
1
37
99.5
98.2
95.9
94.8
92.6
1.3
332
1
2
3
1
1
3
14
3
Segmental or local gastrectomy
351
3
67
95.0
91.2
86.2
82.9
81.2
2.2
224
0
2
2
2
4
17
24
9
Surgical mucosal resection
22
0
5
100.0
89.5
78.9
78.9
73.3
10.2
12
0
0
0
0
0
3
2
0
Table 24
Lymph node dissection (D) (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 ysr (%)
2 ysr (%)
3 ysr (%)
4 ysr (%)
5 ysr (%)
SE at 5 ysr
Alive
Local rec.
Peri-toneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Un-known
D0
802
12
125
80.5
73.7
69.1
67.0
65.6
1.7
420
17
95
34
10
17
18
49
17
D1
2553
15
457
86.4
79.1
74.6
71.2
68.8
1.0
1356
58
276
65
29
56
48
145
63
D1 + α
1684
7
349
92.0
86.1
83.2
80.9
78.6
1.1
1008
39
94
27
13
31
21
77
25
D1 + β
882
2
165
93.5
88.3
85.6
83.5
81.4
1.4
563
18
45
19
8
9
9
33
13
D2
6056
20
907
91.6
82.2
76.0
72.1
69.6
0.6
3424
240
654
183
126
124
53
201
144
D3
343
2
35
82.8
66.6
58.4
51.1
47.7
2.8
138
28
67
21
17
17
3
6
11
Table 25
Resection margins (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 year (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
PM− and DM−
12217
56
2089
91.0
83.1
78.1
74.7
72.3
0.4
6984
355
1102
332
192
240
155
500
268
PM+ and/or DM+
397
7
43
50.9
32.2
23.4
18.4
16.2
2.0
50
34
144
18
15
34
2
27
30
Table 26
Combined resection of neighboring organs (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 year (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
No combined resection
7955
33
1494
92.0
85.6
81.4
78.6
76.5
0.5
4729
193
588
161
80
132
98
326
154
Combined resection
4309
29
615
85.1
73.2
66.3
61.5
58.7
0.8
2032
191
651
183
123
135
55
192
132
PM proximal margin, DM distal margin
Table 27
Combined resected organs (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 year (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
Caudal pancreas
313
1
35
74.2
54.5
45.5
39.7
37.5
2.9
96
28
77
15
17
22
3
10
10
Spleen
1444
10
189
84.7
68.8
59.6
53.7
49.7
1.4
573
80
288
61
70
49
15
68
51
Transverse colon
101
1
19
71.6
52.3
43.0
38.0
36.7
5.2
25
5
27
4
2
9
0
7
3
Transverse mesocolon
53
1
7
82.9
61.4
53.2
40.3
38.1
7.0
15
3
15
2
1
4
0
5
1
Diaphragma
9
0
1
50.8
25.4
0.0
0.0
0.0
0.0
0
0
0
4
2
0
0
1
1
Liver
96
2
11
63.6
49.2
40.2
34.5
33.2
5.0
24
7
11
17
4
8
2
6
6
Gallbladder
2121
12
339
89.1
81.9
77.3
73.5
71.2
1.0
1215
59
213
73
22
40
28
80
52
Adrenal gland
10
0
0
90.0
80.0
80.0
80.0
80.0
12.6
8
1
0
0
0
0
0
0
1
Kidney
7
0
2
85.7
85.7
85.7
68.6
68.6
18.6
3
0
0
0
0
0
1
1
0
Small intestine
10
0
1
90.0
70.0
60.0
60.0
60.0
15.5
5
0
1
0
0
0
0
2
1
Abdominal wall
1
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
1
0
0
0
0
0
Ovary
22
0
3
67.4
52.1
41.7
41.7
41.7
11.0
7
0
11
0
1
0
0
0
0
Pancreas head (PD)
20
2
2
85.0
69.1
58.4
41.8
35.9
11.3
6
2
0
1
0
2
1
5
1
Others
66
0
4
86.4
75.6
67.9
67.9
67.9
5.8
41
1
5
3
2
1
4
2
3
PD pancreatoduodenectomy
Table 28
Curative potential (resected cases)
Categories
No. of patients
Direct death
Lost f.u.
1 year (%)
2 years (%)
3 years (%)
4 years (%)
5 years (%)
SE at 5 years
Alive
Local rec.
Peritoneal
Liver rec.
Distant meta.
R
Other cancer
Other disease
Unknown
A
8102
20
1585
97.8
95.4
92.9
90.6
88.6
0.4
5674
58
119
66
39
39
113
300
109
B
3078
14
398
88.3
72.5
62.1
56.1
52.5
0.9
1318
206
508
137
94
115
39
155
108
C
1505
28
149
49.0
24.7
16.4
12.1
9.9
0.8
109
126
624
150
78
120
3
71
75
Fig. 2
Kaplan–Meier survival for all patients with primary gastric cancer. 5YEARS 5-year survival rate
Fig. 3
Kaplan–Meier survival for resected cases and unresected cases
Fig. 4
Kaplan–Meier survival of resected cases stratified by sex
Fig. 5
Kaplan–Meier survival of resected cases stratified by age
Fig. 6
Kaplan–Meier survival of resected cases stratified by tumor location. W whole stomach
Fig. 7
Kaplan–Meier survival of resected cases stratified by macroscopic type
Fig. 8
Kaplan–Meier survival of resected cases stratified by histological findings
Fig. 9
Kaplan–Meier survival of resected cases stratified by lymphatic invasion
Fig. 10
Kaplan–Meier survival of resected cases stratified by depth of tumor invasion
Fig. 11
Kaplan–Meier survival of resected cases stratified by pT classification
Fig. 12
Kaplan–Meier survival of resected cases stratified by lymph node metastasis
Fig. 13
Kaplan–Meier survival of resected cases stratified by peritoneal cytology
Fig. 14
Kaplan–Meier survival of resected cases stratified by peritoneal metastasis
Fig. 15
Kaplan–Meier survival of resected cases stratified by Japanese Gastric Cancer Association (JGCA) stage
Fig. 16
Kaplan–Meier survival of resected cases stratified by TNM stage
×
×
×
×
×
×
×
×
×
×
×
×
×
×
×
The 5YEARS in 13,626 patients with primary gastric cancer was 68.9 % (Table 1; Fig. 2). During the 5-year follow-up, 2,233 patients were lost; the follow-up rate was 83.6 %. Of the 13,626 patients, 13,002 underwent gastric resection. Accordingly, the resection rate was 95.4 %, and the 5YEARS of the resected patients was 70.7 % (Table 2; Fig. 3). Sixty-three of 13,002 resected cases died within 30 days postoperatively. The direct death rate was 0.48 %. The frequent causes of death in patients who had undergone gastrectomy were peritoneal metastasis (n = 1,283), followed by other diseases (n = 539), local recurrence including node metastasis (n = 410), liver metastasis (n = 357), recurrence at unknown site (n = 278), and other cancer (n = 158).
Anzeige
The proportion of male patients was 68.4 % with 5YEARS of 70.0 %; for female patients 5YEARS was 72.3 %, which was better statistically (Table 3; Fig. 4). Patients more than 80 years old were 7.8 % of all patients, and their 5YEARS was 51.4 % (Table 4; Fig. 5). On the other hand, 5YEARS of the patients under 39 years old was 79.4 % (P < 0.001). Cancer was located in the upper-third of the stomach in 21.1 % of the cases, and its 5YEARS was relatively low at 64.3 % (Table 5; Fig. 6). Patients with type 4 cancer amounted to 7.2 %, and their 5YEARS was markedly low at 17.7 % (Table 6; Fig. 7). The 5YEARS of type 3 was 46.0 % and that of type 2 was 60.4 %. For histological type, frequency of the undifferentiated type including poorly differentiated adenocarcinoma, signet-ring cell carcinoma, and mucinous adenocarcinoma was 46.8 % and its 5YEARS was 65.5 %, which was inferior to that of the differentiated type (75.7 %, P < 0.001; Tables 7, 8; Fig. 8). The grade of lymphatic invasion (ly0–ly3) and venous invasion (v0–v3) showed significant correlations with the prognosis (Tables 9, 10; Fig. 9).
A high incidence of early-stage cancer remained characteristic in 2002, as shown in Tables 11 and 12. The proportion of pathological M and SM (pT1) cancer was 49.7 %, and its primary cause of death was not cancer recurrence (17.9 %, n = 87) or other cancer (18.7 %), but other diseases (49.0 %, n = 238). The proportion of pathological MP and SS (pT2) was 26.8 %, SE (pT3) 19.9 %, and SI (pT4) 3.6 %. The 5YEARS of these subsets were 67.9 %, 30.3 %, and 20.6 %, respectively (Figs. 10, 11). The primary cause of death in advanced cancer was cancer recurrence, and the peritoneal recurrence rate was remarkably high in the pT3 and pT4 subsets. For the lymph node metastasis, the proportion of pN0 was 59.5 %, pN1 20.4 %, pN2 15.9 %, and pN3 4.1 %, and the 5YEARS of each subset was 88.9 %, 58.9 %, 34.6 %, and 14.3 %, respectively (Table 13; Fig. 12).
Peritoneal washing cytology was carried out in 5,836 patients with advanced gastric cancer; the positive rate was 13.0 %. The 5YEARS of cytology-positive (CY1) patients was 12.3 %, which was almost as dismal as the 5YEARS of the P1 patients (8.3 %; Tables 14, 15; Figs. 13, 14). The 5YEARS of patients with liver metastasis (H1) was 11.4 %, and of those with other types of distant metastasis was 12.4 % (Tables 16, 17).
The 5YEARS of the patients stratified by JGCA staging system was 92.2 % for stage IA, 85.3 % for stage IB, 72.1 % for stage II, 52.8 % for stage IIIA, 31.0 % for stage IIIB, and 14.9 % for stage IV. These JGCA 5YEARSs seemed to correlate well with TNM 5YEARSs, which were 92.3 % for stage IA, 84.7 % for stage IB, 70.0 % for stage II, 46.8 % for stage IIIA, 28.8 % for stage IIIB, and 15.2 % for stage IV (Table 18, 19, 20, 21; Figs. 15, 16).
For operative procedures, the proportion of patients who underwent laparoscopic gastrectomy was only 5.1 % in 2002, and their 5YEARS was 93.3 % (Table 22). Eligibility for laparoscopic surgery was strictly limited at that time, and the laparoscopic approach was selected almost exclusively in patients with the preoperative diagnosis of early gastric cancer. Only 1.2 % of the patients were treated by thoracolaparotomy, and their 5YEARS was 35.4 %. Thoracolaparotomy was usually carried out in patients with advanced gastric cancer with esophageal invasion more than 3 cm in length. Total gastrectomy was performed for 30.5 % of the patients, and their 5YEARS was 51.9 % (Table 23). D2 lymph node dissection, a standard procedure for resectable advanced gastric cancer according to the JGCA treatment guidelines, was performed in 49.2 % of the patients (Table 24) [2, 3]. The risk of direct death among those who underwent D2 gastrectomy was only 0.3 %. The proportion of patients treated with less invasive surgery such as proximal gastrectomy, pylorus-preserving gastrectomy, segmental gastrectomy, and local resection of the stomach was 9.8 %. D0, D1, D1 + α, and D1 + β dissection were carried out in 6.5 %, 20.7 %, 13.7 %, and 7.2 % of the patients, respectively. D0 and D1 dissection were carried out mainly in patients with noncurative factors or poor surgical risks. The incidence of positive resection margin (PM+ and/or DM+) was 3.1 % (Table 25). Combined resection of other organs was performed in 35.1 % (Table 26). The frequent combined resected organs in patients who underwent gastrectomy were gallbladder (n = 2121), spleen (n = 1444), caudal pancreas (n = 313), transverse colon (n = 101), liver (n = 96), and so on in descending order (Table 27).
The curative potential of gastric resection was an important prognostic factor. The proportion of patients with no residual tumors with high probability of cure (resection A) was 63.9 %, and their 5YEARS was 88.6 %. On the other hand, patients with definite residual tumors (resection C) amounted to 11.9 % of all patients who underwent laparotomy, and their 5YEARS was 9.9 % (Table 28; Fig. 17).
Fig. 17
Kaplan–Meier survival of resected cases stratified by curative potential of gastric resection
×
Discussion
Estimates of the worldwide incidence, mortality, and prevalence of 26 cancers in the year 2002 were available in the GLOBOCAN series of the International Agency for Research on Cancer [4]. With an estimated 934,000 new cases per year in 2002 (8.6 % of new cancer cases), the incidence of stomach cancer is in fourth place, after cancers of the lung, breast, and colon and rectum. It is the second most common cause of death from cancer (700,000 deaths annually).
The data presented in this report were collected from 208 hospitals in Japan. Cancer incidence rate (annual number of newly diagnosed cases per 100,000 population) in Japan in 2002 was approximately 520 for males and 370 for females. The incidences of various cancers in Japan are estimated from data collected by the cancer registry system in a dozen prefectures. According to these statistics, the number of cancer incidences in 2002 was approximately 589,000. The stomach was the leading site (21 %) for males and the second highest site (14 %) for females. The number of new patients who were diagnosed as gastric cancer in 2002 was estimated to be 106,760 [5]. Accordingly, 13,626 patients registered by this program corresponded to approximately 13 % of the whole population affected by gastric cancer in Japan. Even though these patients may not represent the average features of gastric cancer found in this country, this report is considered to have analyzed the largest number of patients for the past 10 years, clarifying the trends of gastric cancer in Japan. Just for reference, the proportion of patients registered in the nationwide registry of other organs of all patients diagnosed were 6 % in colon cancer, 24 % in esophageal cancer, 25 % in liver cancer, and 26 % in lung cancer, respectively [6].
Anzeige
The reliability of the results in this report depends on the quality of data accumulated in the JGCA database. Because of the complexity of the JGCA staging system, the error checking system on the data entry screen did not function completely. In several categories such as lymph node metastasis (N), the JGCA system could not be converted to the TNM system automatically. Therefore, the registration committee had to make great efforts to confirm raw data sent to the data center from the participating hospitals.
As compared with our archived data of 12,004 patients treated in 2001 [1], the proportion of early cancer declined from 51.2 % to 49.7 % [pT1 (M) cancer, 27.4 % to 25.6 %, and pT1 (SM) cancer, 23.8 % to 24.1 %], suggesting that an increasing number of patients with mucosal cancer were sent for endoscopic treatment. These data suggest that we should start to register gastric patients treated with endoscopic mucosal resection (EMR) and/or endoscopic submucosal dissection (ESD) as soon as possible. The surgical mortality within 30 days significantly improved, from 0.6 % to 0.48 % (P < 0.001). Just for reference, it was 4.0 % in 1963 and 1.0 % in 1991 [7], Moreover, the nationwide database of gastrointestinal surgery in 2008 showed that was 0.2 % in gastrectomy and 0.4 % in total gastrectomy [8].
Accordingly with the rapidly aging society in Japan, the proportion of patients more than 80 years old continued increasing (Fig. 18): it was 0.7 % in 1963, 4.9 % in 1990, 7.0 % in 2001, and 7.8 % in 2002, respectively. Although the risk for surgery increases in elderly patients who have comorbidities, evaluations of risk can allow interventions that may decrease morbidity and mortality. Appropriate treatments should be offered to the elderly. However, these data have the intrinsic weakness of being retrospectively collected 7 years after surgery. Unfortunately, we in Japan continue to have a legal difficulty in registering personal information, which is essential for long-term and prospective follow-up. The overall follow-up rate in our program was 83.5 %. In other words, the outcome of 17.5 % of the patients is unknown. The proportion of patients who were lost to follow-up in the Japanese nationwide registry of colon cancer, liver cancer, and thyroid cancer was 19.6 %, 25.8 %, and 20.6 %, respectively [6]. Rules and regulations regarding handling of these data will have to change radically to overcome the issue of accuracy and reliability of the nationwide registry in Japan, and this could be out of the hands of the surgeons who have contributed to the best of their abilities to gather these data. On the other hand, the Japanese Association of Clinical Cancer Centers, consisting of 25 cancer center hospitals, reported that their follow-up rate was 98.5 %, and 5YEARS of 9,980 patients who underwent surgery from 1997 to 2000 were 90.4 % for TNM stage I, 67.8 % for stage II, 43.3 % for stage III, and 9.3 % for stage IV, respectively [9]. When the patients with gastric cancer had a medical examination in clinical cancer centers, they registered the place where their family records were registered, and office workers of the clinical cancer centers confirmed regularly their safety from the family registration; this was the reason for the extremely high follow-up rate. In the current analyses, 5YEARS in stage IV patients was 15.2 %. We might have overestimated our 5YEARS in stage IV patients, but we found that our follow-up rate increased as the stage advanced; the follow-up rate of stage IV patients was 90.4 %. These data suggest that the lower follow-up rate may not have had serious effects on 5YEARSs in our program. Although, the correlation between follow-up rate and survival rate is complicated, our follow-up system needs to be improved if we are to evaluate the survival rates more accurately.
Fig. 18
Chronological change of gastric cancer patients older than 80 years. The nationwide registry was suspended for a decade from 1992
×
Cytological examination was conducted in 3,481 (59.4 %) of 5,857 patients with T2, T3, or T4 cancer. The 5YEARS of CY1 patients was 12.3 % and their 5YEARS was as poor as that of patients with peritoneal metastasis. Although this examination was not carried out commonly in the days of 2002, it could still be regarded as a significant and independent prognostic factor from the data that were available. These findings further support the need for staging laparoscopy for accurate preoperative staging in patients with advanced gastric cancer.
Anzeige
JGCA restarted a nationwide registration from 2008. The object of the new nationwide registry was primarily to calculate the stage-specific 5YEARSs among patients who underwent gastrectomy. Therefore, the structure of the database was required to be simple, and the number of registration items was kept to a minimum. Undoubtedly, the next objective would be to collect and analyze data of patients with inoperable disease, remnant gastric cancer, gastrointestinal stromal tumor, malignant lymphoma of the stomach, and other entities that were excluded in the current project. We also began to register patients who were treated by EMR/ESD by adding additional items and updating data entry software from 2011.
We hope that this report will be useful when surveying trends and changes in the clinical practice and treatment results of gastric cancer in Japan. Details of the individual data presented in this report will soon become available for scientific and clinical research with the permission of the registration committee. In addition, most of the surgical and pathological data could easily be transferred to the international database in the near future for various analyses. The registration committee will continue the efforts to improve the registration system, ultimately to collect meaningful annual data.
Acknowledgments
The JGCA Registration Committee appreciates the great effort of participating hospitals in registering accurate and detailed data for this project. I wish to express my great gratitude to Ms. Yoshimi Sugamura, Niigata University Medical and Dental Hospital, for her valuable assistance.
Conflict of interest
The authors declare that there are no conflicts of interest related to the contents of this manuscript.
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Open Access
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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Data of gastric cancer patients in this report were collected from the surgical or gastrointestinal departments of the following 208 hospitals (in alphabetical order): Akashi Municipal Hospital, Aomori City Hospital, Asahikawa Medical University Hospital, Cancer Institute Hospital, Chiba Cancer Center, Chiba University Hospital, Dokkyo Medical University Hospital, Ebina General Hospital, Fuchu Hospital, Fujita Health University (Banbuntane Houtokukai Hospital), Fukaya Red Cross Hospital, Fukui Red Cross Hospital, Fukuoka University Chikushi Hospital, Fukuoka University Hospital, Fukushima Medical University Hospital, Gifu Prefectural General Medical Center, Gifu University Hospital, Gunma Prefectural Cancer Center, Gunma University Hospital, Hakodate Goryoukaku Hospital, Hakodate Municipal Hospital, Hamamatsu University School of Medicine, University Hospital, Handa City Hospital, Health Insurance Hitoyoshi General Hospital, Higashiosaka City General Hospital, Himeji Central Hospital, Hiroshima City Asa Hospital, Hiroshima City Hospital, Hiroshima Prefectural Hospital, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima University Hospital, Hitachi General Hospital, Hokkaido University Hospital, Hoshigaoka Koseinenkin Hospital, Hospital, University of the Ryukyus, Hyogo Cancer Center, Hyogo Prefectural Nishinomiya Hospital, Ibaraki Prefectural Central Hospital, Ibaraki Seinan Medical Center Hospital, Ishikawa Prefectural Central Hospital, Iwate Medical University Hospital, Iwate Prefectural Central Hospital, Iwate Prefectural Kamaishi Hospital, Izumi Municipal Hospital, JA Hiroshima Kouseiren Hiroshima General Hospital, Japanese Red Cross Medical Center, Jikei University School of Medicine, Jikei University Aoto Hospital, Juntendo University Juntendo Hospital, Jusendo Medical Hospital, Kagawa Prefectural Central Hospital, Kagawa Medical University Hospital, Kakogawa Municipal Hospital, Kanagawa Cancer Center, Kanazawa University Hospital, Kansai Electric Power Hospital, Kansai Rousai Hospital, Kawasaki Medical School Hospital, Keio University Hospital, Keiyukai Sapporo Hospital, Kimitsu Chuo Hospital, Kinki Central Hospital, Kinki University Hospital, Kiryu Kosei General Hospital, Kitakyushu Municipal Medical Center, Kobe Century Memorial Hospital, Kobe City Medical Center General Hospital, Kouchi Medical School Hospital, Kumamoto Medical Center, Kumamoto Regional Medical Center, Kumamoto University Hospital, Kurashiki Central Hospital, Kurobe Kyosai Hospital, Kuroishi General Hospital, Kurume University Hospital, Kushiro Rosai Hospital, Kyorin University Hospital, Kyoto Second Red Cross Hospital, Kyoto University Hospital, Kyushu University Hospital, Matsushita Memorial Hospital, Matsuyama Red Cross Hospital, Misawa City Hospital, Mitoyo General Hospital, Miyagi Cancer Center, Mizushima Kyodo Hospital, Muroran City General Hospital, Musashino Red Cross Hospital, Nagahama City Hospital, Nagano Municipal Hospital, Nagano Red Cross Hospital, Nagaoka Chuo General Hospital, Nagasaki Municipal Hospital, Nagoya University Hospital, Nakagami Hospital, Nanpuh Hospital, Nara Medical University Hospital, Nara Hospital, Kinki University Faculty of Medicine, National Cancer Center Hospital, National Defense Medical College Hospital, NHO Ciba Medical Center, NHO Kasumigaura Medical Center, NHO Kyushu Cancer Center, NHO Osaka Medical Center, NHO Sendai Medical Center, NHO Shikoku Cancer Center, NHO Tokyo Medical Center, NHO Yokohama Medical Center, Nihon University Itabashi Hospital, Nihon University Surugadai Hospital, Niigata Cancer Center Hospital, Niigata City General Hospital, Niigata Prefectural Shibata Hospital, Niigata Prefectural Yoshida Hospital, Niigata University Medical and Dental Hospital, Nippon Koukan Hospital, Nippon Medical School Chiba Hokusoh Hospital, Nippon Medical School Hospital, Nishi-kobe Medical Center, NTT West Osaka Hospital, Obihiro Tokushukai Hospital, Oita Red Cross Hospital, Oita University Hospital, Okayama University Hospital, Okitama Public General Hospital, Onomichi Municipal Hospital, Osaka City University Hospital, Osaka General Medical Center, Osaka Kouseinenkin Hospital, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka Medical College Hospital, Osaka Police Hospital, Osaka Red Cross Hospital, Osaka Seamen’s Insurance Hospital, Osaka University Hospital, Otsu Municipal Hospital, Otsu Red Cross Hospital, Rinku General Medical Hospital, Sado General Hospital, Saga University Hospital, Saiseikai Chuwa Hospital, Saiseikai Fukuoka General Hospital, Saiseikai Kumamoto Hospital, Saiseikai Niigata Daini Hospital, Saiseikai Noe Hospital, Saiseikai Utsunomiya Hospital, Saitama Medical Center, Saitama Medical Center Jichi Medical University, Saitama Red Cross Hospital, Saitama Social Insurance Hospital, Saku Central Hospital, Sapporo City General Hospital, Sapporo Medical Center, Sapporo Medical University Hospital, Sapporo Social Insurance General Hospital, Sayama Hospital, Seirei Hamamatsu General Hospital, Shakaihoken Kobe Central Hospital, Shiga University of Medical Science Hospital, Shimonoseki City Central Hospital, Shinnittetsu Yahata Memorial Hospital, Shinshu University Hospital, Shizuoka Cancer Center, Showa Inan Hospital, Showa University Northern Yokohama Hospital, Showa University Toyosu Hospital, Social Insurance Central General Hospital, Social Insurance Kinan Hospital, Southern Tohoku General Hospital, St. Luke’s International Hospital, St. Marianna University School of Medicine Yokohama City West Hospital, Suita Municipal Hospital, Sumitomo Hospital, Suwa Red Cross Hospital, Takeda General Hospital, Tochigi Cancer Center, Toho University Ohashi Medical Center, Tohoku University Hospital, Tokushima Municipal Hospital, Tokushima Prefectural Central Hospital, Tokushima University Hospital, Tokyo Medical University Ibaraki Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo Women’s Medical University (Institute of Gastroenterology), Tokyo Women’s Medical University Hospital, Tokyo Women’s Medical University Medical Center East, Tonami General Hospital, Toranomon Hospital, Tottori Municipal Hospital, Toyama Prefectural Central Hospital, Toyama University Hospital, Toyohashi Municipal Hospital, Tsuchiura Kyodo General Hospital, Tsukuba University Hospital, University Hospital Kyoto Prefectural University of Medicine, University of Fukui Hospital, University of Miyazaki Hospital, University of Yamanashi Hospital, Wakayama Medical University Hospital, Yamachika Memorial General Hospital, Yamagata Prefectural Central Hospital, Yamagata University Hospital, Yamaguchi Rousai Hospital, Yamanashi Prefectural Central Hospital, Yao Municipal Hospital, Yodogawa Christian Hospital, Yokohama City University Hospital, Yokohama City University Medical Center, and Yuri Kumiai General Hospital.
Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.
Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?
Dr. med. Mihailo Andric Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.
