Comparison of Surgical Therapy of Gastric Cancer in Japan and Germany 演題 ３４ Momoko Chiba M1,Mayumi Yamaguchi1, Natsumi Ishikawa1, Shotaro Miyashita1, Megumi Ohmiya1, Masaki Yamaguchi1, Sarah Bockholt2・Hildegard Wichtmann3, Yoshikazu Noto4, Jan C. Becker5, Dirk Domagk6, Wolfram Domschke7, Michiaki Masuda8, Wolfgang R. Ade8 1) Dokkyo Medical University, 5th Year 2) Westphalian Wilhelms-University, 6th Year, 3 Westphalian Wilhelms-University, 5th Year, 4) Dokkyo Medical University, Division of Languages and Humanities, 5) Westphalian Wilhelms-University, IfAS, 6) Josephs-Hospital Warendorf, Internal Medicine, 7) Westphalian Wilhelms-University, 8) Dokkyo Medical University, Office for German-Japanese Cooperation Introduction: Gastric Cancer involves major morbidity and mortality. Both in Germany and Japan,  surgical resection still constitutes the principal therapeutical intervention.  Methods Germany Only differentiation between D1 and D2 compartment (whereas in Japan there is also a D1+ compartment) We compared operative treatment in Japan and Germany based on a literature search and discussions with researchers in Japan and Germany. D1-compartment D2-compartment D3-compartment Therapy Algorithm in Japan 1) Laparotomy versus Laparoscopic Surgery Comparison of the number of cases of laparoscopic surgery and open surgery in Japan (Target data: January 1, 2011 - December 31, 2011) Gastric malignancy surgery (by laparoscope) 3937 Gastric malignancy surgery 1. Resection, simple 4711 Gastric malignancy surgery 2. Resection, extensive 20636 Gastric malignancy surgery 3. Totally, simple単純 2600 Gastric malignancy surgery 4.Totally, extensive2. Others 12112 Gastric malignancy surgery 4. Totally, extensive 1. With pedicled gut transplantation 416 Laparoscopic adjuvant gastric malignancy surgery 1. Resection 8949 Laparoscopic adjuvant gastric malignancy surgery 2. Total resection 1788 Japan: Number of Cases operated on at the First Department of Surgery, Dokkyo Medical University, Mibu Therapy Algorithm in Germany 2) Laparoscopic operations increased due the extension of the indication to T2N0 cases. Germany: Benefit of laparoscopic surgery not yet proven     Post-operative Chemotherapy Similar in Japan and Germany. Commonly used chemotherapeutic agents are for example: Tegafur/gimeracil/oteracil (S-1), Cisplatin and Doxetacel Japan 1. Standard gastrectomy Gastrectomy with curative intent (Resection of at least two-thirds of the stomach and D2 lymph node dissection) 2. Non-standard gastrectomy The extent of gastric resection and lymph node dissection is altered according to the disease stage (incl. modified resection & extended resection）. 5-year Survival Rate 4) Japan: Population-based cancer registry in Japan（Diagnosed 2003-2005） 63.3% Germany: Robert-Koch-Institut 33% Discussion Gastric cancer is among the three most frequent cancer types in Japan. Its incidence tends to decrease worldwide, but the number of  patients still shows an increase in Japan due to the aging of the population. In contrast to Germany, Japan offers screening  for gastric cancer and more than half of the cases are detected at an early stage.  On the other hand, in Germany many cases are detected at an advanced stage.  This explains the difference in overall survival data. Basically diagnostic methods and the therapy algorithms in both countries are very similar. But in Germany the Laurén classification has a greater relevance to the decision of surgical procedures than in Japan.  Lymph node dissection range for each operation 3) Relative survival rate for 10 years after first diagnosis by gender ICD-10 C-16 Germany 2011-2012 1. Total gastrectomy (Figure 1) D0: Lymphadenectomy less than D1 D1: No. 1 to 7 D1+: D1 + No. 8a, 9, 11p D2: D1 + No. 8a, 9, 10, 11 p, 11 d, 12a 2. Distal gastrectomy (Figure 2) D1: No. 1, 3, 4sb, 4d, 5, 6, 7 D1+: D1 + No. 8a, 9 D2: D1 + No. 8a, 9, 11p, 12a 3. Pylorus-preserving gastrectomy (Figure 3) D1: No. 1, 3, 4sb, 4d, 6, 7 4. Proximal gastrectomy (Figure 4) D1: No. 1, 2, 3a, 4sa, 4sb, 7 Fig. 1 Fig. 2 Fig. 3 Fig. 4 References 1) Japanese Gastric Cancer Association. Japanese Gastric Cancer Treatment Guidelines 2014 (ver. 4). 24 June, 2016, 2) German Therapy Algorithm http://www.klinikmanual.de/page.php?id=135&category=flowch Viewed Nov.14.2016 3) Japanese Surgical Society. 113th Annual Meeting. April 1, 2013 https://www.jssoc.or.jp/other/info/info20130430.pdf, Viewed Nov. 14, 2016 4) Cancer Statistics in Japan – 2015. Foundation for Promotion of Cancer Research. Chuo-ku, Tokyo. Japanese Gastric Cancer Association 1991 Address of gratitude The authors thank Dr. Bernhard Marschall for enabling the training program for students of Dokkyo Medical University at the University of Münster and Dr. Kinro Sasaki of the 1st Dep. Of Surgery, Dokkyo Medical University, Mibu, for providing information on the gastric cancer operations at his department.