Standards for surgical therapy of gastric cancer

Gastric cancer (GC) continues to represent a formidable health challenge worldwide based on its unaltered high incidence in certain geographic areas such as East Asia or South America, its commonly advanced stage at diagnosis, and its limited curability for disease in intermediate and advanced stages. Even in the United States, where gastric adenocarcinoma mortality has gradually decreased from the most common form of cancer-related deaths in the 1940s and gastric cancer incidence is among the lowest in the world, curability remains a significant problem. Before the onset of surgical therapy, gastric cancer was incurable. Since the first groundbreaking accomplishments with partial gastrectomy by Billroth in 1881, Y–jejunostomy reconstruction by Roux in 1893, and total gastrectomy by Schlatter in 1897, operative therapy of gastric malignancy has gone through more than a century of continued refinement and ever–improving accomplishments. This chapter intends to highlight the critical objectives, indications, and standard techniques for operative procedures in gastric cancer treatment and to describe the position of surgical therapy within the context of multidisciplinary approaches for mid-stage and metastatic stomach malignancy.