Controversies in management of gastric cancer

The rates of relapse and death remain high in gastric cancer patients especially in advanced stages. Local relapses in the tumor bed and regional lymph nodes and distant spread result in a failure after a R0 resection. Even following significant advances in chemotherapy, survival rates continue to be dismal. A multidisciplinary team approach is the way forward and could possibly reduce the recurrence rates and hence improve survival. As a result of several prospective, randomized trials, many surgeons view the large volume of international opinion concerning optimal gastric cancer treatment as having been filtered clean. But does this view withstand detailed scrutiny? This new therapeutic approach in gastric cancer is rapidly evolving and has led to a series of controversies on the best strategy to follow. Emphasizing existing trial findings and controversies, this review hopes to illuminate the topic, so the reader can reach his own conclusions.