Update on treatment of gastric cancer.

Surgery is the main treatment for curing gastric cancer. Early diagnosis provides an excellent survival outcome via an improved detection of early gastric cancer and an improved resection rate. The extent of lymphadenectomy surgery has been under debate for a long time. In East Asian countries, especially Japan, Korea, and Taiwan, gastrectomy with D2 dissection is routinely performed. By contrast, in most Western countries, gastrectomy with D1 dissection is performed, due to lower mortality and morbidity. Recently, acceptance of D2 surgery has increased in Western countries because: (1) modified D2 lymphadenectomy (preservation of pancreas and spleen) improves operative morbidity and mortality; (2) Western surgeons can be trained to performed D2 lymph node dissection on Western patients safely; and (3) D2 resection decreases locoregional recurrence and prolongs survival. Current guidelines in the United States and Europe suggest modified D2 dissection is recommended, but needs to be performed by high-volume centers with experienced surgeons. Adjuvant or perioperative chemotherapy should be prescribed for gastric cancer with Stage II or III disease, due to its marked benefits of reducing disease recurrence and increasing long-term survival. Patients with inoperable advanced gastric cancer should receive chemotherapy to improve their survival and quality of life if an acceptable performance status can be achieved. Targeted therapy with trastuzumab should be considered in patients with HER-2/neu overexpression who have a higher response rate and a longer survival.