XXXX : surgery in 2011.

@entity5 @entity1 @entity420 @entity356
BACKGROUND: Treatment of @entity356 is more and more becoming an individualized decision. The choice of the optimal approach is based on prognostic factors, on the anatomic site of the @entity5 , and on expectations about the response to neoadjuvant treatment. @entity356 that is limited to the mucosal layer is the domain of endoscopic resections. As soon as the submucosal layer is invaded, surgical strategies with adequate lymphadenectomy become necessary. DISCUSSION: In many East Asian Centers and some other centers in the world, these @entity5 are resected by a laparoscopic approach. With a high experience, this can be done with excellent quality and outcome. In locally advanced @entity356 , multimodal treatment can improve survival in comparison to surgery alone. However, the strategies differ significantly around the world. While adjuvant chemoradiotherapy is standard in the USA, in Europe, perioperative chemotherapy is the first choice, and in Japan, adjuvant chemotherapy is recommended. In Europe, three randomized phase III studies on the value of preoperative chemotherapy have been performed. Two of them have shown that perioperative chemotherapy does significantly improve the survival of @entity1 with @entity420 and of the esophagogastric junction. The one including only preoperative chemotherapy failed to show a survival benefit for the combined treatment arm but showed excellent outcomes in both the surgery alone and the preoperative chemotherapy arms. Based on these studies, @entity1 with @entity5 are now treated with perioperative chemotherapy. Additionally, it is generally accepted for more than 10 years now that responding @entity1 have a significantly improved prognosis compared to nonresponding @entity1 . The percentage of responding @entity1 varies depending on the applied regimen between 20% and 45%. Therefore, early response evaluation or response prediction is an utmost important field of research. Proximal @entity5 are treated with a transhiatal extended gastrectomy, @entity5 in the middle third with a total gastrectomy, and @entity5 with a subtotal gastrectomy, if possible. Modified D2 lymphadenectomy avoiding splenectomy is now accepted as the standard procedure, providing improved prognosis for certain subgroups of @entity1 . Individualized resection and lymphadenectomy techniques for early @entity5 stages and response-based neoadjuvant concepts for locally advanced @entity5 are the challenge for the future.
