Abstract
Simple SummaryManagement of gastric and gastroesophageal junction (GEJ) adenocarcinoma remains challenging, because of the heterogeneity in tumor biology within the upper gastrointestinal tract. This manuscript is the product of a formal consensus process conducted in three Delphi rounds and a consensus meeting by the GAIN (GAstric cancer Italian Network) group. The goal of this document is to present a synthesis of available evidence and, where this is lacking, to provide expert opinion directed at prevention, diagnosis, and proper management of gastric and GEJ adenocarcinoma, and in particular aspects of practical management not fully supported by guidelines.Background: Management of gastric and gastroesophageal junction (GEJ) adenocarcinoma remains challenging, because of the heterogeneity in tumor biology within the upper gastrointestinal tract. Daily clinical practice is full of grey areas regarding the complexity of diagnostic, staging, and therapeutic procedures. The aim of this paper is to provide a guide for clinicians facing challenging situations in routine practice, taking a multidisciplinary consensus approach based on available literature. Methods: The GAIN (GAstric cancer Italian Network) group was established with the aims of reviewing literature evidence, discussing key issues in prevention, diagnosis, and management of gastric and GEJ adenocarcinoma, and offering a summary of statements. A Delphi consensus method was used to obtain opinions from the expert panel of specialists. Results: Forty-nine clinical questions were identified in six areas of interest: role of multidisciplinary team; risk factors; diagnosis; management of early gastric cancer and multimodal approach to localized gastric cancer; treatment of elderly patients with locally advanced resectable disease; and treatment of locally advanced and metastatic cancer. Conclusions: The statements presented may guide clinicians in practical management of this disease.
Highlights
Gastric cancer represents a significant health problem—it is the third leading cause of cancer death worldwide, incidence varies widely [1]
The GAIN (GAstric cancer Italian Network) group was established with the aim of filling this gap between evidence and practice
Experts in the field selected the major open questions in the management of gastric and gastroesophageal junction (GEJ) adenocarcinoma, reviewed literature evidence, discussed key issues in prevention, diagnosis, and management, and provided recommendations to be used in clinical practice
Summary
Gastric cancer represents a significant health problem—it is the third leading cause of cancer death worldwide, incidence varies widely [1]. Management of gastric and gastroesophageal junction (GEJ) adenocarcinoma remains challenging, because of the heterogeneity of tumor biology within the upper gastrointestinal tract; the complexity of diagnostic, staging, and therapeutic procedures; and differences in treatment algorithms [2]. Experts in the field selected the major open questions in the management of gastric and GEJ adenocarcinoma, reviewed literature evidence, discussed key issues in prevention, diagnosis, and management, and provided recommendations to be used in clinical practice. The aim of this paper is to provide a guide for clinicians facing challenging situations in routine practice, taking a multidisciplinary consensus approach based on available literature. Methods: The GAIN (GAstric cancer Italian Network) group was established with the aims of reviewing literature evidence, discussing key issues in prevention, diagnosis, and management of gastric and GEJ adenocarcinoma, and offering a summary of statements. Conclusions: The statements presented may guide clinicians in practical management of this disease
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