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World J Gastrointest Oncol. Oct 15, 2014; 6(10): 393-402
Published online Oct 15, 2014. doi: 10.4251/wjgo.v6.i10.393
Multimodality management of resectable gastric cancer: A review
Helen Shum, Lakshmi Rajdev
Helen Shum, Lakshmi Rajdev, Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, United States
Author contributions: Shum H and Rajdev L contributed to this paper.
Correspondence to: Lakshmi Rajdev, MD, MS, Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, 1695 Eastchester Road, 2nd Floor, Bronx, NY 10461, United States. lrajdev@montefiore.org
Telephone: +1-718-4058404 Fax: +1-718-4058433
Received: May 23, 2014
Revised: July 1, 2014
Accepted: September 6, 2014
Published online: October 15, 2014
Core Tip

Core tip: Gastric adenocarcinoma is a difficult disease to treat. Surgical resection is the definitive therapy but recurrences are frequent. The use of a multidisciplinary approach to treatment decision-making is imperative. Surgical resection should be an R0 resection (with clear macroscopic and microscopic margins) and at least a D1 lymphadenectomy with a minimum of 15 lymph nodes sampled in the United States and a D2 lymphadenectomy elsewhere. Perioperative chemotherapy is a reasonable option based on the Medical Research Council Adjuvant Gastric Infusional Chemotherapy trial. In patients who are evaluated after resection, adjuvant chemoradiation adds important survival benefit. Other options include adjuvant S-1 in Asian patients, capecitabine/oxaliplatin, and capecitabine/cisplatin.