[General tactical and technical principles]

Gastric cancer requires radical surgery, together with repair of resection by anastomosis in accordance with physiological aspects. There is still no reason for adopting total gastrectomy as the only operative principle. In antral tumours and early cancer there are arguments for and against the general use of total gastrectomy. The Japanese studies underline the favourable effect of a meticulous lymph node dissection on the outcome of the disease. If subtotal resection is performed the Billroth II anastomosis is preferred, as it is more radical. For replacement of the stomach, interposition of a jejunal segment is the procedure of choice. In general there is a trend towards total gastrectomy combined with lymphadenectomy.