Current issues in gastric cancer therapy

Gastric cancer is a major health problem worldwide. The incidence of new cases of gastric adenocarcinoma, the most common form of gastric cancer, varies between different regions. The highest incidence is recorded in Eastern Asia and Latin America. Despite major advances in understanding the biology of gastric cancer, this knowledge did not translate into survival benefit and gastric adenocarcinoma still carries a dismal prognosis. Early diagnosis of gastric cancer, while the tumor is still confined to the gastric wall, can improve survival, as was demonstrated in Japan. However, a mass-screening program which improves survival is not cost-effective in countries where the incidence of gastric cancer is low. Surgical resection remains the mainstay of therapy for localized disease with disease-specific survival rates that vary between 15-65%. Japanese and Korean surgeons report significantly better results compared to surgeons in western countries. The difference in gastric cancer outcome between eastern and western countries can be attributed to the expertise gained by the high incidence of the disease and the aggressive surgical approach towards gastric cancer practiced in Japan and Korea. However, radical lymphadenectomy performed by well trained western surgeons did not yield the same survival advantage observed by Japanese investigators. Other factors such as less aggressive biology of the disease or stage migration due to improved pathologic staging may also explain the results reported by Japanese and Korean investigators. The present review deals with some of the current issues related to gastric cancer therapy including: the role of extended lymphadenectomy, adjuvant therapy and minimal invasive surgery in the treatment of adenocarcinoma of the stomach.