RESUMO
The prognosis of stomach cancer continues to be unfavorable in spite of technical advances in its diagnosis; there has not been much progress in the survival of these patients in the western world. The resectability rate has risen and postoperative mortality has declined, indicating improved surgical management. The different methods of surgical treatment are reviewed, including subtotal or total gastrectomy, extensive lymphadenectomy, and ample resection of perigastric organs by Japanese authors, and we give our personal opinion of this aggressive surgery. The indications for subtotal or total gastrectomy are discussed, as well as the intestinal reconstruction techniques. We review other therapeutic options: intraoperative radiotherapy, immunochemotherapy and chemotherapy. The experience of our service in the surgical treatment of gastric cancer is described. We think that the challenge of treating gastric cancer will be overcome by early diagnosis of the disease, that more aggressive surgery does not help much in advanced cases, and that in our region we are still far from attaining the rates of early diagnosis and survival reported by Oriental surgeons.
