Abstract
Gastric carcinoma represents a fascinating disease in terms of the history, development, philosophy, and future of the field of surgical oncology. Many facets of gastric carcinoma intrigue us: the long-term decline in incidence in the United States and other western countries [1], the rapid improvement in stage that has been seen in Japan as a result of widespread population screening [2], the evolution of sophisticated histologic analysis separating better and poorer prognostic histologic types (Lauren classification) [3], the recent significant proximal shift in the location of gastric cancers [4], the inability to find any effective systemic therapy to improve prognosis [5], and the unsubstantiated enthusiasm for a far more radical surgical approach [6,7] to gastric cancer, including radical lymph node removal, recreating a philosophical trend and surgical strategy of the 1950s long since discredited in all other human cancer surgery. This last feature has led to several randomized trials comparing the extent of regional lymph node and stomach resection in an appropriate attempt to evaluate the revived surgical philosophy and strategy [6,8-10]. The history of gastric cancer surgery and the results of these recent prospective clinical trials reaffirms and supports basic surgical oncology principles.
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