title: Surgical management of advanced gastric cancer: An evolving issue.
abstract: Worldwide, gastric cancer represents the fifth most common cancer and the third leading cause of cancer deaths. Although the overall 5-year survival for resectable disease was more than 70% in Japan due to the implementation of screening programs resulting in detection of disease at earlier stages, in Western countries more than two thirds of gastric cancers are usually diagnosed in advanced stages reporting a 5-year survival rate of only 25.7%. Anyway surgical resection with extended lymph node dissection remains the only curative therapy for non-metastatic advanced gastric cancer, while neoadjuvant and adjuvant chemotherapies can improve the outcomes aimed at the reduction of recurrence and extension of survival. High-quality research and advances in technologies have contributed to well define the oncological outcomes and have stimulated many clinical studies testing multimodality managements in the advanced disease setting. This review article aims to outline and discuss open issues in current surgical management of advanced gastric cancer.
authors.affiliation: General, Minimally Invasive and Robotic Surgery, Department of Surgery, "San Matteo degli Infermi" Hospital, ASL Umbria 2, Via Loreto 3, 06049, Spoleto PG, Italy. Electronic address: marano.luigi@email.it.
authors.forename: L
authors.initials: L
authors.lastname: Marano
authors.affiliation: Department of Medical, Surgical and Neuroscience; Unit of General and Minimally Invasive Surgery, University of Siena, Viale Bracci 11, 53100, Italy.
authors.forename: K
authors.initials: K
authors.lastname: Polom
authors.affiliation: General, Minimally Invasive and Robotic Surgery, Department of Surgery, "San Matteo degli Infermi" Hospital, ASL Umbria 2, Via Loreto 3, 06049, Spoleto PG, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Patriti
authors.affiliation: Section of Pharmacology and University Center DIFF - Drug Innovation Forward Future, Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25124 Brescia, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Roviello
authors.affiliation: Surgery Unit IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Falco
authors.affiliation: General Surgery, Department of Surgery, "Santa Marta e Santa Venera" Hospital, ASL Catania 3, 95124, Acireale CT, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Stracqualursi
authors.affiliation: Department of Surgical Oncology, National Cancer Research Centre - Istituto Tumori "G. Paolo II", Bari, Italy.
authors.forename: R
authors.initials: R
authors.lastname: De Luca
authors.affiliation: Medical Oncology Unit, University of Siena, Viale Bracci 11, 53100, Siena, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Petrioli
authors.affiliation: Department of Medical, Surgery and Health Sciences, University of Trieste, Piazza Ospitale 1, 34129 Trieste, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Martinotti
authors.affiliation: Department of Surgery, AO Istituti Ospitalieri di Cremona, Cremona, 26100, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Generali
authors.affiliation: Department of Medical, Surgical and Neuroscience; Unit of General and Minimally Invasive Surgery, University of Siena, Viale Bracci 11, 53100, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Marrelli
authors.affiliation: 8th General and Gastrointestinal Surgery, Department of Internal Medicine, Surgical, Neurological Metabolic Disease and Geriatric Medicine, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Di Martino
authors.affiliation: Department of Medical, Surgical and Neuroscience; Unit of General and Minimally Invasive Surgery, University of Siena, Viale Bracci 11, 53100, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Roviello
mesh_terms: D017024:Chemotherapy, Adjuvant; D017326:Clinical Trials, Phase III as Topic; D005260:Female; D005743:Gastrectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D007263:Infusions, Parenteral; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016019:Survival Analysis
keywords: Advanced gastric cancer; HIPEC; Laparoscopic surgery; Lymphadenectomy; Robotic surgery