The current state of stomach cancer surgery in the world

The incidence of gastric cancer and the number of gastric cancer patients that a surgeon treats annually are so vastly different between countries and regions that it is not easy to define which type of gastric cancer surgery should be considered the global standard. Nevertheless, a consensus that D2 dissection is the most appropriate way to treat resectable advanced gastric cancer has arguably been reached after long-term follow-up and flexible interpretation of the Dutch D1 versus D2 trial and evidence from the Japan Clinical Oncology Group 9501 study which denied survival benefit of more extensive lymphadenectomy. After the Japan Clinical Oncology Group 9501 trial, surgeons gradually lost interest in attempting to improve survival through extended resection and instead began to expend greater resources on establishing and standardizing the technique of minimally invasive surgery and proving its oncological non-inferiority compared with the conventional approach. Laparoscopic distal gastrectomy has become an option in daily clinical practice in the Far East, and more demanding procedures such as laparoscopic total gastrectomy and laparoscopic surgery for advanced gastric cancer are currently being explored in clinical trials from the viewpoint of both safety and oncological feasibility. In addition, the high proportion of early-stage cancer in the Far East prompted surgeons to develop limited surgery such as proximal gastrectomy and pylorus-preserving gastrectomy, which warrant further evaluation regarding benefits in terms of postoperative nutritional state and/or quality of life measurements to convince the rest of the world.