Surgical Management of Advanced Gastric Cancer

ABSTRACT

Although the proportion of early gastric cancer has increased, that of advanced gastric cancer (AGC) is still high. The overall prognosis of AGC has gradually improved over the past decades with advances in surgical techniques as well as multimodality treatments. Nevertheless, the outcome of AGC still remains poor and worldwide standard treatment guideline has not been established. Radical gastrectomy is the gold standard of management or gastric cancer worldwide, as the complete surgical removal of tumors (R0 resection) confers the only chance for cure. However, the extent of lymph node dissection has been debated between East and West. Radical gastrectomy with extended D2 lymphadenectomy is the accepted standard in Eastern countries, whereas limited D1 lymphadenectomy with chemoradiotherapy is more frequently used in Western countries. Role of splenectomy and laparoscopic surgery for AGC is still debatable and should be proved by long-term oncologic outcomes from large-scale randomized controlled trials.