Gastric cancer has been one of the great malignant scourges affecting man kind for as long as medical records have been kept. Until operative resection pioneered by Bilroth and others became available, no effective treatment was feasible and death from cancer was virtually inevitable. Even with resection by total gastrectomy, the chances of tumor eradication remained small. Over recent years, however, the situation has been changing. Some changes have resulted from better understanding of the disease, early detec tion, and better management techniques with applied clinical research, but the reasons for other changes are poorly understood. For example, the incidence of gastric cancer is decreasing, especially in westernized societies, where it has fallen from one of the most common cancers to no longer being in the top five causes of cancer death. Still it remains the number one killer of adult males in Japan and Korea. Whether the reduced incidence in western societies is a result of dietary changes or methods of food preservation, or some other reason, is as yet uncertain. Improvements in outcome have been reported from mass screening and early detection; more refined techniques of establishing early diagnosis, tumor type, and tumor extent; more radical surgical resection; and resection at earlier stages of disease.

Although there has been a slow but steady decrease in incidence, gastric cancer remains the second leading cause of cancer death worldwide. Several aspects of the oncological and surgical management are still controversial and so gastric cancer represents a challenge for the surgeon. This book aims to delineate the state of the art in the surgical and oncological treatment of gastric cancer, describing the new TNM staging system, the extent of visceral resection and lymphadenectomy focusing on the different open and minimally invasive surgical techniques and discussing intraoperative chemohyperthermia and neoadjuvant and adjuvant treatment. Operative endoscopy and endoscopic ultrasonography are also discussed, as these now have an important role in both diagnostic work-up and palliative care of gastric cancer patients. Only a multidisciplinary approach involving the surgeon, gastroenterologist, and oncologist can produce the comprehensive and integrated overview that today constitutes a winning strategy for the optimization of results.What we hope we have achieved is a flexible, up-to-date, exhaustive publication, rich in illustrations and consistent with evidence-based medicine.

This book clearly describes the surgical procedures employed in patients with gastric cancer. The techniques used in the various types of gastrectomy are presented step by step, and the roles of endoscopic treatment and chemotherapy are also discussed. A distinctive practical feature is the provision of accompanying online videos of standard surgical procedures, which will serve as excellent learning aids for novice practitioners and provide ideal teaching material for experienced surgeons. Surgery remains the mainstay in the treatment of gastric cancer. With advances in tumor biology and technical developments, gastric cancer surgery has become more diverse and its outcomes have steadily improved. However, further improvement of certain aspects of surgical procedures and techniques is still required. Surgery for Gastric Cancer will acquaint readers with the state of the art in the field and prove a valuable tool in the quest for optimal practice.

Included here is a discussion of the pathophysiological aspects and risks of laparoscopic staging (such as trocar metastases) on the basis of international experience.

This volume provides the most comprehensive and complete resource available on all aspects of gastric cancer and it’s management. The book covers topics such as oncologic approaches to staging, treating, and following patients, filling a critical need for resource materials on these areas. As multidisciplinary care is an integral part of gastric cancer treatment, this text is unique in including a renowned group of expert authors from a variety of disciplines, including pathology, gastroenterology, medical oncology, surgery and clinical genetics. In addition, authors from an international pool of gastric cancer experts have covered the breadth of practice and understanding globally. Edited and organized by an expert from one of the most highly respected cancer institutions in the country, Gastric Cancer: Principles and Practice is an expert review of this field, serving as a valuable reference for physicians in training and in practice, as well as for researchers who are interested in the scope of issues and advances in this important malignancy.

One reason for failure to cure solid tumors by surgery appears to be the impossibility of controlling metastases that are present but latent at the time of operation. This failure is a common clinical experience with aggressive neoplasms. but it is not always appreciated in tumors with longer survival times. e. g .• breast and colon cancer. In addition. recent evidence indicates that after resection of a primary tumor micrometas tases from it might be enhanced by suppression of immune and reticu loendothelial functions of the host. Other factors, such as increase of coagulability and stress in the perioperative period, can also promote tumor growth. The development of new metastases might be facilitated by cells forced into the circulation during operative manipulations. Such events could be important for the outcome of treatment and it is suggested that preventive measures should be directed to this systemic component of solid tumors. Radical surgery can reduce the number of tumor cells to a subclinical 3 6 stage (10 to 10 cells) in which chemotherapy might be more effective than in advanced stages. Chemotherapy, on the other hand, might aggravate the surgical morbidity by influencing the wound healing pro cess, by decreasing the immune response, and/or by toxicity to the bone marrow and to the gastrointestinal tract, for example.

The overall prognosis for patients with gastric cancer remains poor as tumors are often diagnosed at an advanced stage, despite new developments and technical advances in endoscopic diagnosis and therapy. This publication brings together leading experts in the fields of basic research and clinical management of gastric cancer, to share their expertise with the clinical community. State-of-the-art reviews discuss the pathogenesis of and the most important risk factors for the development of gastric cancer, potential benefits of chemoprevention and Helicobacter pylori eradication. Moreover, new diagnostic modalities and surgical therapy, including the potential benefits of neoadjuvant and adjuvant therapies, are presented. As most patients require palliative therapy because of locally advanced or metastasized cancers, several reviews are dedicated to advances in the chemotherapy of advanced gastric cancers and peritoneal metastasis. Finally, future approaches towards a molecular diagnosis and therapy are described. Those involved in the management of gastric cancer patients will find the information presented in this publication of utmost help and will benefit greatly for their daily routine.