ABSTRACT
Gastric cancer remains one of the commonest causes of death from cancer worldwide, despite a decreasing incidence, particularly in Western countries (1). The majority of patients with this disease present at an advanced stage, especially in Western countries, and the chances of a cure for patients with advanced disease remain low. Surgery remains the mainstay of treatment, but because of the poor survival rates, the use of adjuvant and neoadjuvant chemotherapy and radiotherapy have been explored, as have more radical surgical techniques. The latter, in the form of D2 extended lymphadenectomy, has remained highly controversial in the world of gastric surgery over the last three decades. Even more radical surgery (D4 dissection) is still contemplated in Japan. Endoscopic mucosal resection seems now to have a useful and defined role in early cancer. Minimally invasive surgery is now reaching a stage of development where its role needs to be clarified. Surgery has a diminishing role in palliation as other methods have supplanted it in several of its symptom-relieving roles.
