[Cancer of the stomach: for a revised strategy]

The "revisionist" approach to therapy of gastric cancer needs a previous demonstration of the qualitative comparability of Japanese and western treatments of gastric adenocarcinoma. Early gastric cancer is far more common in Japanese than in Occidentals, but its character is the same, and for identical stages and treatments, the prognosis is the same. But many western studies show serious methodological deficiencies (staging, anatomopathological examination...), as well as a serious lack of interest in adjuvant therapy, a potential source of progress. We propose a 4-point therapeutic approach inspired by the Japanese example: a greater methodological rigor, standardization of lymphadenectomies, the definition of therapeutic subgroups to receive optimal treatments, the development of new adjuvant treatments.