Surgical treatment of gastric cancer. Oncological standards and technical progress

Gastric cancer is one of the few tumor entities with a decreasing incidence but still constitutes a main cause of cancer-related deaths worldwide. The gold standard in therapy regimes with curative intent is surgery; however, palliative regimes should also include surgery in selected cases. Minimally invasive techniques are becoming established leading to improved perioperative outcomes. Review of current oncological standards with a focus on the surgical approach in gastric cancer patients, discussion of current controversies regarding surgery with curative and palliative intent and outcomes of minimally invasive techniques. Review of the literature on surgery of gastric cancer including conventional and minimally invasive tecnhniques. Surgery is the gold standard in regimes with curative intent for gastric cancer patients. The histological subtype is the basis for decision-making with respect to the extent of gastric resection. Radical D2 lymphadenectomy is the current standard in western countries. Multivisceral resection for locally advanced cancer is worthwhile in selected patients in terms of improved long-term survival despite potentially higher morbidity rates.. In palliative settings surgery can be a tool to improve the quality of life and to control tumor-related complications Minimally invasive techniques are one of the main technical options to improve the perioperative outcome in gastric cancer patients. Multimodal therapy regimes may improve the quality of life and survival in curative and palliative settings.