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group) will contribute to different stage-specific results. Other possible explanations for the differences include the therapeutic effect of surgical treatment, with more extensive surgery in Japan. The Dutch trial ofD1 vs D2lymphadenectomyshowed no overall improved survival, but improved survival in certain subsets. This trial was extensively discussed later. There may also be different outcomes from the same treatment; Western patients generally have more complications and a higher postoperative mortality after extensive gastric surgery than the Japanese. Patient factors - older, with more cardiovascular and respiratory disease - as well as surgeon-related factors - less experience with the operation and with management of the complications - may be significant. Regarding the possibility that there are biological differences, comparisons of histological and genetic factors of Japanese and European tumors showed no differences. Although the question remains unanswered, it is clearly not appropriate simply to attribute the outcome differences to fundamentally different pathology.

Report of the Eleventh International Symposium of the Foundation for Promotion of Cancer Research: Basic and Clinical Research in Gastric Cancer