Differences in gastric cancer surgery outcome between East and West: differences in surgery or different diseases?

The Dutch D1D2 Trial revealed a noncompliance rate of 51% in gastric cancer patients who should have undergone a D2 dissection, while it disclosed that the D2 lymph node dissection group of patients exhibited a higher 15-year overall survival (OS) rate, lower rates of local and regional recurrence, lower rates of liver metastases and lower cancer-related death rates compared to the D1 group, implying that the surgical technique per se may influence outcomes. On the other hand, the predominant up-regulation of invasive and metastatic genes in the Western tumor libraries, the differences in the criteria used for gastric cancer diagnosis in the East and the steady fnding that the Asian ethnicity is a favorable prognostic factor for patients with gastric cancer treated in the US, have been proposed as possible explanations for the differences observed in the gastric cancer outcome between the East and the West. Moreover, literature addresses that gastric cancers in the East are mainly diagnosed at younger ages, they are of intestinal type, located distally, diagnosed at an early stage of disease, while gastric cancers in the West are mainly affecting elderly patients with comorbidities, they are of diffuse type, located proximally, and diagnosed at an advanced stage of disease. Future discoveries in genetics and molecular biology may clarify the characteristics of each tumor, while future achievements in imaging modalities and biological or target therapies may establish "personalized" therapies. Until that time, all efforts for improving our surgical techniques and optimizing the perioperative care are mandatory.