Surgery and adjuvant chemotherapy.

It was clearly demonstrated that good local control by either radiotherapy or D2 surgery is essential to cure gastric cancer. D2 surgery can be carried out safely with a large volume of patients and can provide better survival than limited surgery. More extended surgery than D2 cannot provide better survival and causes greater morbidity; therefore, it should not be carried out as prophylactic lymphadenectomy. The effect of adjuvant treatment depends on the type of surgery. Neoadjuvant plus post-operative triplet chemotherapy, postoperative adjuvant chemoradiotherapy, and postoperative S-1 monotherapy now are the standards of care in Europe, the United States, and Japan, respectively.