Now and future of gastric cancer surgery

Surgical removal is still the mainstay of gastric cancer treatment, even though endoscopic treatment and systemic chemotherapy are evolving very rapidly.
Current issues of gastric cancer surgery include
1) Minimally invasive surgery; laparoscopic and robotic surgery
2) Function preserving surgery; pylorus preserving gastrectomy (PPG), proximal gastrectomy (PG), and sentinel node navigation surgery (SNNS)
3) Surgery after chemotherapy; so called "conversion surgery" or "palliative surgery"
4) Surgery for elderly and frail patients; how much we can modify our radicality?
5) Standardization within and across countries
KLASS (Korean Laparoscopic Gastrointestinal Study Group) conducted lots of important randomized controlled clinical trials (RCTs) until now, which include RCT comparing open versus laparoscopic distal gastrectomy for cstage I gastric cancer (KLASS-01) and for cstage II-III gastric cancer (KLASS-02), RCT comparing PPG versus distal gastrectomy (KLASS-04), RCT comparing PG versus total gastrectomy (KLASS-05). Other RCTs are now actively enrolling the patients with gastric cancer.
The key finding of KLASS trials are
1) Laparoscopic surgery provides less complication compared to open surgery, without compromising long term outcome.
2) However, QOL and nutritional parameters are not different between laparoscopic versus open surgery, or function preserving surgery versus conventional surgery
Other important Korean surgical clinical trials such as REGATTA and SENORITA also revealed that (1) no survival benefit of surgical resection for stage IV gastric cancer, (2) SNNS can be applied in a part of early gastric cancer.
I will discuss these issues in my presentation with updated data and personal experiences.