Surgical management of gastric cancer: the East vs. West perspective

Gastric cancer is a unique malignancy, with definite geographic differences in incidence, pathology, treatment and outcome. While the incidence has been declining in the Western hemisphere, steady rates have been reported in Eastern countries, particularly South Korea and Japan. One of the most profound differences between the East and West centers around treatment strategies, with Western clinicians routinely adopting a neoadjuvant approach, prior to surgical resection. Eastern clinicians, however, favor primary surgical therapy and have pioneered many of the techniques currently used worldwide. From endoscopic therapies to minimally-invasive surgery, including laparoscopic and robotic techniques, the Eastern surgeons have studied their techniques with high-volumes of patients. Western surgeons, practicing in systems where gastric cancer care is not centralized, typically have performed less aggressive surgical resections, although generally see more advanced diseases. In the era where global care is becoming more standardized, however, the differences in surgical practice have lessened. This review compares the surgical techniques and outcomes for gastric cancer practiced in the East with those standard in the West.