Surgery: The surgical strategy of the Japanese Research Society for Gastric Cancer was based on gastric lymphatic drainage. D2 radical gastrectomy has been advocated and practised as standard surgery in Japan for the past 30 years. In D2 radical gastrectomy, all of the lymph nodes are retrieved from the resection specimen and examined for micrometastasis, which sometimes may be difficult to see intraoperatively. This is in contrast to the Western world, where conventional limited D1 radical gastrectomy is more commonly performed. Japanese series demonstrated a survival benefit using D2 resection. However, this was not proven in the Western world. In a recent prospective, randomized controlled trial, D2 resections were associated with significantly higher mortality and morbidity, which may nullify the survival benefits from D2 procedures. Further, the difference could also be accounted for partially by understaging in the Western world, where less regional lymph nodes were resected. In addition, the number of tumours diagnosed in Japan could have been overstaged, because some of the stage 1 carcinomas diagnosed in Japan were reported to be dysplasia by Western pathologists. Endoscopic treatment: Therapeutic endoscopy for gastric cancer is a minimally invasive procedure that aims for complete cancer removal in early gastric cancer, palliation by recanalization or hemostasis of cancer bleeding. Endoscopic mucosal resection proposed by Tada et al has been preformed in patients with early gastric cancer in the absence of lymph node involvement, whereas the endoscopic laser ablation technique offers high efficacy in treating deeper invasive cancers. Shop with best online pharmacy and find cialis professional getting the most out of it.