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Gastric cancer is the third leading cause of cancer-related deaths worldwide. Over 95% of gastric cancers are adenocarcinomas, which are typically classified based on anatomic location and histologic type. Gastric cancer generally carries a poor prognosis because it is often diagnosed at an advanced stage. Systemic therapy can provide palliation, improved survival, and enhanced quality of life in patients with locally advanced or metastatic disease. The implementation of biomarker testing, especially analysis of HER2 status, microsatellite instability (MSI) status, and the expression of programmed death-ligand 1 (PD-L1), has had a significant impact on clinical practice and patient care. Targeted therapies including trastuzumab, nivolumab, and pembrolizumab have produced encouraging results in clinical trials for the treatment of patients with locally advanced or metastatic disease. Palliative management, which may include systemic therapy, chemoradiation, and/or best supportive care, is recommended for all patients with unresectable or metastatic cancer. Multidisciplinary team management is essential for all patients with localized gastric cancer. This selection from the NCCN Guidelines for Gastric Cancer focuses on the management of unresectable locally advanced, recurrent, or metastatic disease.

Gastric cancer is the fifth most frequently diagnosed cancer and the third leading cause of death from cancer in the world. Several advances have been made in the staging procedures, imaging techniques, and treatment approaches. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Gastric Cancer provide an evidence- and consensus-based treatment approach for the management of patients with gastric cancer. This manuscript discusses the recommendations outlined in the NCCN Guidelines for staging, assessment of HER2 overexpression, systemic therapy for locally advanced or metastatic disease, and best supportive care for the prevention and management of symptoms due to advanced disease., (Copyright © 2016 by the National Comprehensive Cancer Network.)

Introduction: Surgery remains one of the major treatment options available to patients with gastric cancer. The aim of this study was to develop a preoperative nomogram based on the presence of comorbidities to predict the risk of perioperative mortality following gastric resections for malignancy., Methods: The Nationwide Inpatient Sample (NIS) database was used to create a nomogram using SAS software. The training set (years 1993, 1996-97, 1999-2000, 2002, 2004-05) was used to develop the model which was further validated using the validation set (years 1994-95, 1998, 2001, and 2003)., Results: A total of 14,235 and 9,404 patients were included in the training and validation sets, respectively, with overall actual observed perioperative mortality rates of 5.9 % and 6.6 %, respectively. The decile-based calibration plots for the training and validation sets revealed a good agreement between the observed and nomogram-predicted probabilities. The accuracy of the nomogram was further reinforced by a concordance index of 0.75 (95 % confidence interval 0.73 to 0.77) which was calculated using the validation set., Conclusion: This preoperative nomogram may accurately predict the risk of perioperative mortality following gastric resections for malignancy and may be used as an adjunctive clinical tool in the preoperative counseling of these patients.

Surgical resection remains the mainstay of treatment for localized gastric adenocarcinoma. The type and extent of resection depends on tumor location. Although the incidence of gastric cancer has been declining, a shift has occurred to more tumors involving the proximal compared with the distal stomach. Appropriate treatment depends on a thorough staging process to exclude the presence of distant metastatic disease. Current staging modalities include high-quality CT scan, endoscopic ultrasound, PET, and laparoscopy. The value of peritoneal lavage to detect occult peritoneal disease is under investigation. The principles of surgical resection have always included negative resection margins and adequate lymph node examination. Controversial topics requiring further study include laparoscopic resections and hepatic metastasectomy. This review highlights the salient points of current surgical management of gastric adenocarcinoma.