Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2016; 22(17): 4307-4320
Published online May 7, 2016. doi: 10.3748/wjg.v22.i17.4307
Recent developments and innovations in gastric cancer
Mehmet Mihmanli, Enver Ilhan, Ufuk Oguz Idiz, Ali Alemdar, Uygar Demir
Mehmet Mihmanli, Ufuk Oguz Idiz, Uygar Demir, Department of General Surgery, Sisli Etfal Training and Research Hospital, Istanbul 34371, Turkey
Enver Ilhan, Department of General Surgery, Izmir Bozkaya Training and Research Hospital, Izmir 35170, Turkey
Ali Alemdar, Department of General Surgery, Okmeydani Training and Research Hospital, Istanbul 34384, Turkey
Author contributions: Mihmanli M and Ilhan E contributed equally to this work, generated the figures and wrote the manuscript; Idiz UO, Alemdar A, Demir U contributed to the writing of the manuscript; Mihmanli M designed the aim of the editorial and wrote the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Mehmet Mihmanli, MD, Professor, Department of General Surgery, Sisli Etfal Training and Research Hospital, Halaskargazi caddesi, Istanbul 34371, Turkey.
Telephone: +90-5322853159
Received: January 26, 2016
Peer-review started: January 28, 2016
First decision: March 7, 2016
Revised: March 14, 2016
Accepted: March 30, 2016
Article in press: March 30, 2016
Published online: May 7, 2016

Gastric cancer has an important place in the worldwide incidence of cancer and cancer-related deaths. It can metastasize to the lymph nodes in the early stages, and lymph node metastasis is an important prognostic factor. Surgery is a very important part of gastric cancer treatment. A D2 lymphadenectomy is the standard surgical treatment for cT1N+ and T2-T4 cancers, which are potentially curable. Recently, the TNM classification system was reorganized, and the margins for gastrectomy and lymphadenectomy were revised. Endoscopic, laparoscopic and robotic treatments of gastric cancer have progressed rapidly with development of surgical instruments and techniques, especially in Eastern countries. Different endoscopic resection techniques have been identified, and these can be divided into two main categories: endoscopic mucosal resection and endoscopic submucosal dissection. Minimally invasive surgery has been reported to be safe and effective for early gastric cancer, and it can be successfully applied to advanced gastric cancer with increasing experience. Cytoreductive surgery and hyperthermıc intraperıtoneal chemotherapy were developed as a combined treatment modality from the results of experimental and clinical studies. Also, hyperthermia increases the antitumor activity and penetration of chemotherapeutics. Trastuzumab which is a monoclonal antibody interacts with human epidermal growth factor (HER) 2 and is related to gastric carcinoma. The anti-tumor mechanism of trastuzumab is not clearly known, but mechanisms such as interruption of the HER2-mediated cell signaling pathways and cell cycle progression have been reported previously. H. pylori is involved in 90% of all gastric malignancies and Japanese guidelines strongly recommend that all H. pylori infections should be eradicated regardless of the associated disease. In this review, we present innovations discussed in recent studies.

Keywords: Gastric, Cancer, Endoscopic mucosal resection, Endoscopic submucosal resection, Minimally invasive surgery, Neoadjuvant chemotherapy, Human epidermal growth factor receptor 2

Core tip: Gastric cancers are distinguished from other cancers by their high mortality and morbidity. Many studies have been conducted to improve the quality of life and extend the survival rates of patients, and some of these studies are ongoing. Although promising developments have been made in recent years, the obtained results have limited reliability and benefits. We believe that significant improvements in the treatment of gastric cancer will be developed according to the long-term results of ongoing randomized clinical trials.