Casino and political heavyweight Sheldon Adelson is being treated for cancer and has been away from the office since late December, according to media quoting Las Vegas Sands Corporation. The 85 year old chairman and CEO of Las Vegas Sands – his family holds a majority stake – and its Macau subsidiary Sands China Limited, Adelson reigns as the most powerful figure in Asian gaming.

Thanks to Adelson’s visionary bet on a swampy landfill dubbed Cotai, Sands China has the most gaming tables and hotel rooms in Macau and vies with Galaxy Entertainment for the leading market share in the world’s top casino destination, with more than four times the gaming revenue of the Las Vegas Strip. Singapore’s Marina Bay Sands is an architectural icon and financial paragon as the world’s most profitable casino resort. Overall, LVS derives 90% of Ebitda from Asia.

Adelson projects a dominating personality, but LVS boasts a deep corporate bench. LVS president and COO Rob Goldstein appears to be standing in for Adelson for now. Seasoned Hong Kong development executive Wilfred Wong has made the transition to Sands China president and COO, and the transformation of Sands Cotai Central into Londoner seems right up his alley. Marina Bay Sands president and CEO George Tanasijevich spearheads LVS efforts to obtain a Japan integrated resort license in his role as global development director.

Japan is the biggest thing to come along in Asian, if not global gaming, since Macau, with a potential market in the tens of billions of dollars, and the competition is entering a critical phase. Under the rules established by Japan’s government, potential IR locations must assemble a development package to present to the central government to compete for a license. So casino operators have to decide which location(s) they wish to compete in, which means creating detailed plans and finding Japanese partners.

MGM Resorts International has already declared that it’s focusing on Osaka, the only big city that’s currently moving forward with conviction toward an IR application. LVS has been thought to favor the Tokyo area, but no potential host jurisdictions have stepped forward with the vigor of Osaka. It’s a situation where you’d want to consult the resident visionary.

LVS faced a similar situation in the final stages of bidding for Macau’s gaming licenses. In July 2001, Adelson was felled by peripheral neuropathy, a neuromuscular disorder that makes it difficult for him to stand and walk. The treatment for it left him “a bit coo-coo” through early 2002, when Adelson’s medical doctor wife, Miriam Ochsorn Adelson, found a medication that allowed him to return to work.

During Adelson’s absence, his then-president and COO William Weidner put together the bid for Macau, thrown a curve ball due to the 9/11 attacks that crimped travel and thus Las Vegas revenue. LVS needed to find a financing partner for the bidding to supply a US$500 million guarantee, and chose a Taiwan bank with strong ties to the Kuomintang, avowed enemy of Beijing. Macau authorities loved LVS, hated the Taiwan connection and introduced the American casino experts to Galaxy, a blue chip developer with impeccable political credentials and no gaming experience. That partnership won a Macau license, all with Adelson sidelined, and the same thing could happen in Japan.

Of course, when Adelson returned to action in 2002, he soured on the Galaxy partnership. Some say it was about the pace and scale at which LVS wanted to spend Galaxy’s money. Others contend Adelson realized that Macau presented such an enormous opportunity, he didn’t want to share it with a partner, and as Las Vegas recovered from 9/11, LVS could afford to pay its own way. Macau officials resolved the partnership impasse by splitting the concession in two, letting LVS and Galaxy each run its own casinos.

That level of accommodation probably won’t be available in Japan. So, with or without the resident visionary, today’s far more Asia savvy LVS better get it right on the first try.