Discrepant results in long-term survival between United States and Japanese patients with resectable gastric adenocarcinoma may result from more accurate staging in the Japanese series. The authors compared a comprehensive fat-clearing method with the conventional pathology method of lymph node sampling in 11 patients undergoing curative gastrectomy and extended lymphadenectomy at their institution. Comprehensive fat-clearing doubled total lymph node counts ( P < 0.01), identified smaller lymph nodes ( P < 0.001), and identified more histologically involved nodes of significantly smaller size ( P < 0.001). Comprehensive fat-clearing pathologically upstaged 29% of the authors' eligible specimens. Accurate pathologic staging is necessary when comparing Japanese and United States survival data for resectable gastric adenocarcinomas. Cancer 66:1828-1832,1990. HE 5-YEAR SURVIVAL RATES for Japanese patients
T with gastric adenocarcinoma undergoing curative surgery is superior to survival rates in the United States and other Western countries.'-5 Japanese surgeons have made great strides in the surgical treatment of gastric adenocarcinoma, which is the most common malignancy and most common cause of cancer death in J a ~a n . ~-~ Their success is greatly attributable to nationwide massscreening programs, resulting in a higher percentage of earlier staged carcinoma^.^ However, even when compared stage for stage, Japanese patients appear to survive longer than patients in England4 and the United state^.^,^ There are several possible explanations for this difference in survival. First, the biologic behavior of gastric adenocarcinoma in Japan may be less aggressive than in the United States. Second, the surgical therapy, in the form of extended R2 or R3 lymphadenectomy in Japan, may be more effective than the generally applied standard R1 lymphadenectomy in the United States. Third, the