Department of Gastric Surgery

Takaki Yoshikawa, Yukinori Yamagata, Tsutomu Hayashi, Takeyuki Wada, Kenichi Ishizu

Introduction

Our division surgically treats patients with gastric cancer, adenocarcinoma of the esophago-gastric junction, and gastrointestinal stromal tumors (GIST) and also aims to contribute to people through the treatment we provide and the research we perform in this field. Our policies to achieve this goal are: (1) to provide high-quality treatment for patients, (2) to perform clinical tasks efficiently, and (3) to help refine treatment through clinical trials and research and provide high-quality education.

The Team and What We Do

(1) To provide high-quality treatment, we introduced a daily morning conference to determine the optimal treatment strategy for new patients and patients who required any new treatment. All staff members check the endoscopy and CT elements, determine the stage of the tumor based on uniform criteria, then discuss the treatment strategy for each patient, including any issues when applying standard treatment and whether the patient is a viable candidate for any clinical trials. After introducing the Enhanced Recovery After-Surgery program (ERAS) for perioperative care, surgical morbidity and hospital stays were dramatically improved.

(2) To streamline clinical tasks, we prepared the medical documents for patients to ensure uniform explanation and a printed protocol at the conference room and outpatient clinic to check the applicability to the clinical trials. We also eased the burden on physicians and residents by eliminating the need for them to prepare the database.

(3) Our division operated on a total of 278 cases of gastric cancer, GIST, and others this year (Table 1). Details on the surgical procedures are shown in Table 2. The proportion of laparoscopic surgery increased from 49% (2017) to 65% (2018) to 62% (2019) to 62% (2020) and 74% (2021) for distal / pylorus-preserving gastrectomy and from 12% (2017) to 21% (2018) to 44% (2019) to 37% (2020) and 46% (2021) for total / proximal gastrectomy. In particular, we performed 10 robot-assisted distal gastrectomies, 16 proximal gastrectomies, and 10 total gastrectomies without morbidity. Conversely, there were many extended surgeries. We gained experience of numerous cases of D2 plus para-aortic nodal dissection following neoadjuvant chemotherapy for bulky nodal disease or para-aortic nodal metastasis and several cases of left upper abdominal exenteration for bulky GIST invading adjacent organs and lower mediastinal dissection through a trans-hiatal approach and a right video-assisted trans-thoracic approach for gastric cancer invading the lower esophagus. We can perform any type of surgery for local control if applicable. Lastly, we presented the overall survival curves of 6556 patients who received surgery between 2000 and 2016 (Figure 1). The overall survival rate at 5 years was 95.6% in stage IA, 92.9% in stage IB, 88.7% in stage IIA, 80.5% in stage IIB, 71.0% in stage IIIA, 63.1% in stage IIIB, 42.4% in stage IIIC, and 17.2% in stage IV following the 15th edition of the Japanese Classification of Gastric Cancer.

Table 1. Number of operations performed in our department in 2021

Figure 1. Survival curves of 6556 patients who received a gastrectomy during 2000-2016

Clinical trials

In JCOG trials, we continued accrual of new patients for JCOG1507 phase III (surgery alone vs S-1 for elderly patients with pathological stage II/III gastric cancer), JCOG1509 phase III (surgery followed by adjuvant chemotherapy vs neoadjuvant chemotherapy of S-1/oxaliplatin followed by surgery and adjuvant chemotherapy for patients with SS/SE gastric cancer invading lymph nodes), JCOG1704 phase II (neoadjuvant chemotherapy of DOS followed by D2 plus para-aortic nodal dissection and adjuvant chemotherapy), JCOG1711 phase III (omentectomy vs omental preservation for SS/SE gastric cancer), JCOG1809 phase II (laparoscopic splenic hilar nodal dissection for upper gastric cancer invading the greater curvature), JCOG1902 single arm phase III (ESD for submucosal gastric cancer in the elderly patients), and JCOG1907 phase III (laparoscopic vs robotic gastrectomy for clinical stage I/IIA gastric cancer), while following up on the patients who had enrolled in the clinical trials JCOG1104 phase III (8 courses of S-1 vs 4 courses of S-1 for stage II), JCOG1301C randomized phase II (neoadjuvant chemotherapy of S-1/CDDP with or without trastzumab for HER2 positive gastric cancer invading lymph nodes), and JCOG1401 single arm phase III (laparoscopic total / proximal gastrectomy for stage I).

In collaborative research with the UK, the Netherlands, Singapore, and Germany, we published several papers in Br J Surg, Lancet Digit Health, and Gut.

This year, we started a safety lead-in part of a global phase III study to confirm the efficacy of durvalumab, a new PDL-1 antibody, in addition to FLOT, a Western standard perioperative chemotherapy for stage II/III gastric cancer.

Education

Through an open conference to determine the tumor staging and treatment strategy, the trainees could study the nature of standard treatment, issues regarding the applicability of standard therapy, and the nature of investigational treatment. They could also experience first / second assistance of surgery by experienced staff members, scopists conducting laparoscopic surgery, and even operators instructed by experienced staff members. To obtain certification from an endoscopic surgeon, trainees could experience animal training and receive video reviews from experienced staff members. Following the success of a past resident, a chief resident this year obtained the certification from an endoscopic surgeon although the pass rate for that exam is around 20%. In our department, the pass rate has been over 80% since 2018.

Young surgeons also continued clinical research and published a total of seven English papers in J Cancer, BMC Surg, Eur J Surg OncolX4, and BMC Cancer.

Future prospects

We will continue providing high-quality treatment, streamlining clinical tasks and clinical trials and conducting clinical research and education in the field of gastric surgery to contribute to people.

List of papers published

Journal

1. Hironaka S, Sadachi R, Machida N, Iwasa S, Yamada Y, Sasako M, Yoshikawa T, Boku N, Terashima M. Association of renal function with the safety and efficacy of cisplatin plus S-1 therapy and docetaxel plus cisplatin plus S-1 therapy in patients with advanced gastric cancer: an exploratory analysis of JCOG1013. Japanese journal of clinical oncology, 52:14-23, 2022

2. Misawa K, Kurokawa Y, Mizusawa J, Takiguchi S, Doki Y, Makino S, Choda Y, Takeno A, Tokunaga M, Sano T, Sasako M, Yoshikawa T, Terashima M. Negative impact of intraoperative blood loss on long-term outcome after curative gastrectomy for advanced gastric cancer: exploratory analysis of the JCOG1001 phase III trial. Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 25:459-467, 2022

3. Kamiya A, Yoshikawa T, Sakon R, Ishizu K, Wada T, Hayashi T, Otsuki S, Yamagata Y, Katai H. Optimal surgery and lymph node metastasis of duodenal bulbar neuroendocrine neoplasms. European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 48:597-603, 2022

4. Wada T, Yoshikawa T, Sekine S, Kamiya A, Hayashi T, Otsuki S, Yamagata Y, Katai H. Pathological complete response at the para-aortic nodes as a possible surrogate endpoint in gastric cancer surgery with para-aortic node dissection after neoadjuvant chemotherapy. European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 48:333-338, 2022

5. Tokunaga M, Yoshikawa T, Boku N, Nishida Y, Tanahashi T, Yamada T, Haruta S, Etoh T, Hirahara N, Kawachi Y, Tsuji K, Kinoshita T, Kanazawa T, Tokumoto N, Fujita J, Terashima M. Impact of COVID-19 on gastric cancer treatment in Japanese high-volume centers: a JCOG stomach cancer study group survey. Surgery today, 52:231-238, 2022

6. Hasegawa H, Shitara K, Takiguchi S, Takiguchi N, Ito S, Kochi M, Horinouchi H, Kinoshita T, Yoshikawa T, Muro K, Nishikawa H, Suna H, Kodera Y. A multicenter, open-label, single-arm phase I trial of neoadjuvant nivolumab monotherapy for resectable gastric cancer. Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 25:619-628, 2022

7. Cho H, Hashimoto T, Naka T, Yatabe Y, Oda I, Saito Y, Yoshikawa T, Sekine S. Activating KRAS and GNAS mutations in heterotopic submucosal glands of the stomach. Journal of gastroenterology, 57:333-343, 2022

8. Yamada H, Takeshima H, Fujiki R, Yamashita S, Sekine S, Ando T, Hattori N, Okabe A, Yoshikawa T, Obama K, Katai H, Kaneda A, Ushijima T. ARID1A loss-of-function induces CpG island methylator phenotype. Cancer letters, 532:215587, 2022

9. Komori K, Kano K, Aoyama T, Hara K, Nagasawa S, Nakazono M, Shimoda Y, Maezawa Y, Kumazu Y, Kawabe T, Numata M, Hayashi T, Yamada T, Tamagawa H, Sato T, Cho H, Yukawa N, Rino Y, Yoshikawa T, Ogata T, Oshima T. Clinical Impact of Surgical Sarcopenia on Long-term Survival . Anticancer research, 42:4545-4552 , 2022

10. Kamiya A, Hayashi T, Sakon R, Ishizu K, Wada T, Otsuki S, Yamagata Y, Katai H, Yoshikawa T. Prognostic Impact of Long-term Postoperative Pneumonia in Elderly Patients with Early Gastric Cancer . Journal of Cancer, 13:2905-2911 , 2022

11. Naka T, Hashimoto T, Cho H, Tanabe N, Yoshida T, Yatabe Y, Yoshikawa T, Abe S, Sekine S. Sporadic and Familial Adenomatous Polyposis-associated Foveolar-type Adenoma of the Stomach . The American journal of surgical pathology, 0:0, 2022

12. Kumazu Y, Hasegawa S, Hayashi T, Yamada T, Watanabe H, Hara K, Shimoda Y, Nakazono M, Nagasawa S, Rino Y, Masuda M, Ogata T, Oshima T, Yoshikawa T. Should the splenic hilar lymph node be dissected for the management of adenocarcinoma of the esophagogastric junction? . European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 0:0, 2022

13. Yamada T, Hayashi T, Fujikawa H, Kumazu Y, Nagasawa S, Nakazono M, Kano K, Hara K, Watanabe H, Komori K, Shimoda Y, Takahashi K, Ogata T, Oshima T, Yoshikawa T. Feasibility and Safety of Oral Nutritional Supplementation with High-Density Liquid Diet After Total Gastrectomy for Gastric Cancer . World journal of surgery, 46:2433-2439 , 2022

14. Aoyama T, Yoshikawa T, Ida S, Cho H, Sakamaki K, Ito Y, Fujitani K, Takiguchi N, Kawashima Y, Nishikawa K, Nunobe S, Hiki N. Effects of perioperative eicosapentaenoic acid-enriched oral nutritional supplement on the long-term oncological outcomes after total gastrectomy for gastric cancer . Oncology letters, 23:151 , 2022

15. Kawakami T, Mizusawa J, Hasegawa H, Imazeki H, Kano K, Sato Y, Iwasa S, Takiguchi S, Kurokawa Y, Doki Y, Boku N, Yoshikawa T, Terashima M. Usefulness of an S-1 dosage formula: an exploratory analysis of randomized clinical trial (JCOG1001) . Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 0:0, 2022

16. Kamiya A, Hayashi T, Sakon R, Ishizu K, Wada T, Otsuki S, Yamagata Y, Katai H, Yoshikawa T. Long-term postoperative pneumonia in elderly patients with early gastric cancer . BMC surgery, 22:220 , 2022

17. Oshima T, Tsuburaya A, Yoshida K, Yoshikawa T, Miyagi Y, Rino Y, Masuda M, Guan J, Tan P, Grabsch HI, Sakamoto J, Tanaka S. Gastric cancer biomarker analysis in patients treated with different adjuvant chemotherapy regimens within SAMIT, a phase III randomized controlled trial . Scientific reports, 12:8509 , 2022

18. Hagi T, Kurokawa Y, Mizusawa J, Fukagawa T, Katai H, Sano T, Misawa K, Fukushima N, Kawachi Y, Sasako M, Yoshikawa T, Terashima M. Impact of tumor-related factors and inter-institutional heterogeneity on preoperative T staging for gastric cancer . Future oncology (London, England), 18:2511-2519 , 2022

19. Silva ANS, Saito Y, Yoshikawa T, Oshima T, Hayden JD, Oosting J, Earle S, Hewitt LC, Slaney HL, Wright A, Inam I, Langley RE, Allum WH, Nankivell MG, Hutchins G, Cunningham D, Grabsch HI. Author response to: Increasing frequency of gene copy number aberrations is associated with immunosuppression and predicts poor prognosis in gastric adenocarcinoma . The British journal of surgery, 109:e106 , 2022

20. Hayashi T, Yoshikawa T, Ishizu K, Tsutsui M, Wada T, Yamagata Y, Katai H. Suprapancreatic nodal dissection should not be uniformly selected in additional gastrectomy for the patients who diagnosed as pT1b gastric cancer by endoscopic resection . European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 48:1785-1789 , 2022

21. Hayashi T, Yoshikawa T. Reply to: Letter to the Editor “Suprapancreatic nodal dissection should not be uniformly selected in additional gastrectomy for the patients diagnosed as pT1b gastric cancer by endoscopic resection” . European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 48:1867-1868 , 2022

22. Yanagimoto Y, Kurokawa Y, Doki Y, Yoshikawa T, Boku N, Terashima M. Surgical and perioperative treatment strategy for resectable esophagogastric junction cancer . Japanese journal of clinical oncology, 52:417-424 , 2022

23. Silva ANS, Saito Y, Yoshikawa T, Oshima T, Hayden JD, Oosting J, Earle S, Hewitt LC, Slaney HL, Wright A, Inam I, Langley RE, Allum W, Nankivell MG, Hutchins G, Cunningham D, Grabsch HI. Increasing frequency of gene copy number aberrations is associated with immunosuppression and predicts poor prognosis in gastric adenocarcinoma . The British journal of surgery, 109:291-297 , 2022

24. Kang YK, Morita S, Satoh T, Ryu MH, Chao Y, Kato K, Chung HC, Chen JS, Muro K, Kang WK, Yeh KH, Yoshikawa T, Oh SC, Bai LY, Tamura T, Lee KW, Hamamoto Y, Kim JG, Chin K, Oh DY, Minashi K, Cho JY, Tsuda M, Sameshima H, Chen LT, Boku N. Exploration of predictors of benefit from nivolumab monotherapy for patients with pretreated advanced gastric and gastroesophageal junction cancer: post hoc subanalysis from the ATTRACTION-2 study . Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 25:207-217 , 2022

25. Sundar R, Barr Kumarakulasinghe N, Huak Chan Y, Yoshida K, Yoshikawa T, Miyagi Y, Rino Y, Masuda M, Guan J, Sakamoto J, Tanaka S, Tan ALK, Hoppe MM, Jeyasekharan AD, Ng CCY, De Simone M, Grabsch HI, Lee J, Oshima T, Tsuburaya A, Tan P. Machine-learning model derived gene signature predictive of paclitaxel survival benefit in gastric cancer: results from the randomised phase III SAMIT trial . Gut, 71:676-685 , 2022

26. Abe S, Oguma J, Nonaka S, Suzuki H, Yoshinaga S, Oda I, Saito Y, Daiko H. Novel hybrid endoscopy-assisted larynx-preserving esophagectomy for cervical esophageal cancer (with video). Japanese journal of clinical oncology, 51:1171-1175, 2021

27. Hayashi T, Yoshikawa T. Optimal surgery for esophagogastric junctional cancer. Langenbeck's archives of surgery, 2021

28. Faiz Z, Hayashi T, Yoshikawa T. Lymph node dissection for gastric cancer: Establishment of D2 and the current position of splenectomy in Europe and Japan. European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 47:2233-2236, 2021

29. Yura M, Yoshikawa T, Wada T, Otsuki S, Hayashi T, Yamagata Y, Katai H, Nishida T. The prognostic impact of macroscopic serosal change on resectable advanced gastric cancer. BMC cancer, 21:1056, 2021

30. Ishizu K, Hashimoto T, Naka T, Yatabe Y, Kojima M, Kuwata T, Nonaka S, Oda I, Esaki M, Kudo M, Gotohda N, Yoshida T, Yoshikawa T, Sekine S. APC mutations are common in adenomas but infrequent in adenocarcinomas of the non-ampullary duodenum. Journal of gastroenterology, 56:988-998, 2021

31. Murakami H, Yamada T, Taguri M, Hasegawa S, Yamanaka T, Rino Y, Mushiake H, Oshima T, Matsukawa H, Tani K, Suzuki Y, Ozawa Y, Tanabe H, Osaragi T, Sato T, Tamagawa H, Yukawa N, Yoshikawa T, Imada T, Masuda M, Yamamoto Y. Short-Term Outcomes from a Randomized Screening Phase II Non-inferiority Trial Comparing Omentectomy and Omentum Preservation for Locally Advanced Gastric Cancer: the TOP-G Trial. World journal of surgery, 45:1803-1811, 2021

32. Hayashi M, Yoshikawa T, Yura M, Otsuki S, Yamagata Y, Morita S, Katai H, Nishida T. Intraoperative blood loss as an independent prognostic factor for curative resection after neoadjuvant chemotherapy for gastric cancer: a single-center retrospective cohort study. Surgery today, 51:293-302, 2021

33. Tsuburaya A, Guan J, Yoshida K, Kobayashi M, Yoshino S, Tanabe K, Yoshikawa T, Oshima T, Miyashita Y, Sakamoto J, Tanaka S. Clinical biomarkers in adjuvant chemotherapy for gastric cancer after D2 dissection by a pooled analysis of individual patient data from large randomized controlled trials. Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 24:1184-1193, 2021

34. Boku N, Satoh T, Ryu MH, Chao Y, Kato K, Chung HC, Chen JS, Muro K, Kang WK, Yeh KH, Yoshikawa T, Oh SC, Bai LY, Tamura T, Lee KW, Hamamoto Y, Kim JG, Chin K, Oh DY, Minashi K, Cho JY, Tsuda M, Nishiyama T, Chen LT, Kang YK. Nivolumab in previously treated advanced gastric cancer (ATTRACTION-2): 3-year update and outcome of treatment beyond progression with nivolumab. Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 24:946-958, 2021

35. Terashima M, Fujitani K, Ando M, Sakamaki K, Kawabata R, Ito Y, Yoshikawa T, Kondo M, Kodera Y, Kaji M, Oka Y, Imamura H, Kawada J, Takagane A, Shimada H, Tanizawa Y, Yamanaka T, Morita S, Ninomiya M, Yoshida K. Survival analysis of a prospective multicenter observational study on surgical palliation among patients receiving treatment for malignant gastric outlet obstruction caused by incurable advanced gastric cancer. Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 24:224-231, 2021

36.  Fujitani K, Nakamura K, Mizusawa J, Kuwata T, Shimoda T, Katayama H, Kushima R, Taniguchi H, Yoshikawa T, Boku N, Terashima M, Fukuda H, Sano T, Sasako M. Posttherapy topographical nodal status, ypN-site, predicts survival of patients who received neoadjuvant chemotherapy followed by curative surgical resection for non-type 4 locally advanced gastric cancer: supplementary analysis of JCOG1004-A. Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 24:197-204, 2021

37. Abe S, Takizawa K, Oda I, Mizusawa J, Kadota T, Ono H, Hasuike N, Yano T, Yamamoto Y, Horiuchi Y, Nagata S, Yoshikawa T, Terashima M, Muto M. Incidence and treatment outcomes of metachronous gastric cancer occurring after curative endoscopic submucosal dissection of undifferentiated-type early gastric cancer: Japan Clinical Oncology Group study-post hoc analysis of JCOG1009/1010. Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 24:1123-1130, 2021

38. Tsuyuki S, Takeshima H, Sekine S, Yamagata Y, Ando T, Yamashita S, Maeda S, Yoshikawa T, Ushijima T. Comparable genetic alteration profiles between gastric cancers with current and past Helicobacter pylori infection. Scientific reports, 11:23443, 2021

39. Muti HS, Heij LR, Keller G, Kohlruss M, Langer R, Dislich B, Cheong JH, Kim YW, Kim H, Kook MC, Cunningham D, Allum WH, Langley RE, Nankivell MG, Quirke P, Hayden JD, West NP, Irvine AJ, Yoshikawa T, Oshima T, Huss R, Grosser B, Roviello F, d'Ignazio A, Quaas A, Alakus H, Tan X, Pearson AT, Luedde T, Ebert MP, Jäger D, Trautwein C, Gaisa NT, Grabsch HI, Kather JN. Development and validation of deep learning classifiers to detect Epstein-Barr virus and microsatellite instability status in gastric cancer: a retrospective multicentre cohort study . The Lancet. Digital health, 3:e654-e664 , 2021

40. Ito Y, Fujitani K, Sakamaki K, Ando M, Kawabata R, Tanizawa Y, Yoshikawa T, Yamada T, Hirao M, Yamada M, Hihara J, Fukushima R, Choda Y, Kodera Y, Teshima S, Shinohara H, Kondo M. QOL assessment after palliative surgery for malignant bowel obstruction caused by peritoneal dissemination of gastric cancer: a prospective multicenter observational study . Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 24:1131-1139 , 2021

41. Kamiya A, Katai H, Ishizu K, Wada T, Hayashi T, Otsuki S, Yamagata Y, Yoshikawa T, Sekine S, Nishi T, Kawasaki Y, Ito T, Domoto H. Recurrence after ESD curative resection for early gastric cancer . Surgical case reports, 7:5 , 2021

42. Yamagata Y, Yoshikawa T, Ishizu K, Kamiya A, Wada T, Hayashi T, Otsuki S, Katai H. Is lymph node dissection for neuroendocrine carcinoma of the stomach effective as it is for adenocarcinoma? . European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 47:2004-2009 , 2021

43. Kano K, Yamada T, Yamamoto K, Komori K, Watanabe H, Takahashi K, Maezawa Y, Fujikawa H, Numata M, Aoyama T, Tamagawa H, Cho H, Yukawa N, Yoshikawa T, Rino Y, Masuda M, Ogata T, Oshima T. Evaluation of Lymph Node Staging Systems as Independent Prognosticators in Remnant Gastric Cancer Patients with an Insufficient Number of Harvested Lymph Nodes . Annals of surgical oncology, 28:2866-2876 , 2021

44. Kawazoe A, Shitara K, Boku N, Yoshikawa T, Terashima M. Current status of immunotherapy for advanced gastric cancer . Japanese journal of clinical oncology, 51:20-27 , 2021

45.  Iwasaki Y, Terashima M, Mizusawa J, Katayama H, Nakamura K, Katai H, Yoshikawa T, Ito S, Kaji M, Kimura Y, Hirao M, Yamada M, Kurita A, Takagi M, Lee SW, Takagane A, Yabusaki H, Hihara J, Boku N, Sano T, Sasako M. Gastrectomy with or without neoadjuvant S-1 plus cisplatin for type 4 or large type 3 gastric cancer (JCOG0501): an open-label, phase 3, randomized controlled trial . Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 24:492-502 , 2021

46. Cho H, Yamada M, Sekine S, Tanabe N, Ushiama M, Hirata M, Ogawa G, Gotoh M, Yoshida T, Yoshikawa T, Saito Y, Kuchiba A, Oda I, Sugano K. Gastric cancer is highly prevalent in Lynch syndrome patients with atrophic gastritis . Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 24:283-291 , 2021

47. Tokunaga M, Kurokawa Y, Machida R, Sato Y, Takiguchi S, Doki Y, Yabusaki H, Watanabe M, Hato S, Nakamori M, Ito S, Yoshikawa T, Terashima M. Impact of postoperative complications on survival outcomes in patients with gastric cancer: exploratory analysis of a randomized controlled JCOG1001 trial . Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 24:214-223 , 2021