How Radical Should the Surgical Therapy for Gastric/Cardia Cancer Be?

With the exception of tumours limited to the mucosa, surgical resection of the primary tumour and its local lymph node metastases still remains the sole option for a curative therapy for potentially resectable gastric cancer, as long as a complete tumour resection (R0 resection) can be performed. In this context, the extent of surgical radicality has been discussed over the last years, especially based on the following aspects: 1. extent of lymphadenectomy/need for splenectomy; 2. subtotal versus total gastrectomy; 3. surgical therapy for cardia cancer; 4. operative approach in cT4-tumours; 5. laparoscopic versus open surgery. Based on the recent study results as well as the current guidelines, this review will discuss these specific issues and gives an insight about the recommended surgical radicality in gastric cancer.