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It is widely accepted that survival following gastrectomy for gastric cancer is superior for Japanese patients. Surgeons in Japan have demonstrated that curative resection with extensive lymphadenectomy leads to the high survival rate for gastric cancer, whereas some surgeons in the United States question if superior Japanese outcomes might be explained, in part, by racial factors. Hundahl and colleagues retrospectively compared the stage-stratified survival of gastrectomized Japanese patients in Honolulu treated for gastric cancer according to Western techniques with that of a cohort of Tokyo Japanese patients treated according to Japanese techniques, thus eliminating race as a potentially confounding variable. The authors proposed three hypotheses (the different-disease hypothesis, stage-migration hypothesis, and treatment hypothesis) explaining the better Japanese survival rates and concluded that these results cannot be explained by race-related factors or the different-disease hypothesis, but seem more likely to be explained by the lymphadenectomy-related stage migration and/or therapeutic efficacy.
Inoue K. Invited Commentary. Arch Surg. 1996;131(2):175. doi:10.1001/archsurg.1996.01430140065017