Gastric cancer is one of the most common cancers worldwide. In the basic area, the molecular subtype of gastric cancer has been extensively investigated. The Cancer Genome Atlas (TCGA) project classifies gastric cancer into four genomic subtypes, including Epstein–Barr virus (EBV)-positive, microsatellite instability (MSI), genomically stable (GS) and chromosomal instability (CIN). This classification provides additional information on histopathology and may guide target therapy for distinct populations of gastric cancer patients. Evidence has suggested that EBV-positive type and MSI type may benefit from immunotherapy such as PD-1 and PD-L1. However, the clinical implications of the molecular subtypes have been poorly explained. There is an unmet need to translate these genetic or epigenetic findings of gastric cancer into clinically useful information for early detection, guiding therapy or risk stratification, ultimately improving survival from this deadly disease.
From the clinical aspect, surgery is still the mainstay for the management of gastric cancer. Function-preserving gastrectomy has been increasingly investigated for early gastric cancer in order to improve postoperative nutritional status, including proximal gastrectomy and pylorus-preserving gastrectomy. For locally advanced gastric cancer, minimally invasive surgery has been tried due to the potential benefit of fast recovery, less surgical stress and less postoperative complications. In the Japanese Gastric Cancer Treatment Guidelines, laparoscopy-assisted gastrectomy has been recommended as an option for cStage I carcinomas in the distal stomach. In recent years, more and more researchers have focused on totally laparoscopic gastrectomy or totally robotic gastrectomy. Different lymph node dissection approach and digestive reconstruction methods have been tried, like uncut Roux-en-Y and delta-shaped anastomosis. With the innovation of surgical instruments, three-dimensional laparoscopy and naked-eye laparoscopy has also been introduced into clinical practice. Although minimally invasive surgical procedures seem like an inevitable trend for gastric cancer, there is a poor understanding of the advantages and disadvantages of each procedure or a different surgical approach. Such knowledge would facilitate choosing the best suitable ways of treating patients and would be of great importance for clinical decision-making.
As for advanced gastric cancer, conversion surgery has attracted growing attention. REGATTA trial has failed to demonstrate the survival benefit of reduction surgery for metastatic gastric cancer. However, some study has shown highly selective advanced gastric cancer patients would benefit curative-intent resection after achieving tumor response to chemotherapy. Optimal conversion therapy regimen and optimal time for surgical intervention are a matter of debate.
The goal of this article collection is to focus on the cutting-edge progress in gastric cancer, including translational study, surgical approach, and multidisciplinary management. We welcome the submissions of Review, Mini-Review, and Original Research covering, but not limited to, the following topics:
1) Translational study,
2) Two-dimensional and three-dimensional laparoscopy-assisted or totally laparoscopic gastrectomy,
2) Robot-assisted or totally robotic gastrectomy,
3) Intracorporeal digestive reconstruction after total or subtotal gastrectomy,
4) Functional-preserving surgery for gastric cancer,
5) Multidisciplinary treatment for advanced gastric cancer.
Gastric cancer is one of the most common cancers worldwide. In the basic area, the molecular subtype of gastric cancer has been extensively investigated. The Cancer Genome Atlas (TCGA) project classifies gastric cancer into four genomic subtypes, including Epstein–Barr virus (EBV)-positive, microsatellite instability (MSI), genomically stable (GS) and chromosomal instability (CIN). This classification provides additional information on histopathology and may guide target therapy for distinct populations of gastric cancer patients. Evidence has suggested that EBV-positive type and MSI type may benefit from immunotherapy such as PD-1 and PD-L1. However, the clinical implications of the molecular subtypes have been poorly explained. There is an unmet need to translate these genetic or epigenetic findings of gastric cancer into clinically useful information for early detection, guiding therapy or risk stratification, ultimately improving survival from this deadly disease.
From the clinical aspect, surgery is still the mainstay for the management of gastric cancer. Function-preserving gastrectomy has been increasingly investigated for early gastric cancer in order to improve postoperative nutritional status, including proximal gastrectomy and pylorus-preserving gastrectomy. For locally advanced gastric cancer, minimally invasive surgery has been tried due to the potential benefit of fast recovery, less surgical stress and less postoperative complications. In the Japanese Gastric Cancer Treatment Guidelines, laparoscopy-assisted gastrectomy has been recommended as an option for cStage I carcinomas in the distal stomach. In recent years, more and more researchers have focused on totally laparoscopic gastrectomy or totally robotic gastrectomy. Different lymph node dissection approach and digestive reconstruction methods have been tried, like uncut Roux-en-Y and delta-shaped anastomosis. With the innovation of surgical instruments, three-dimensional laparoscopy and naked-eye laparoscopy has also been introduced into clinical practice. Although minimally invasive surgical procedures seem like an inevitable trend for gastric cancer, there is a poor understanding of the advantages and disadvantages of each procedure or a different surgical approach. Such knowledge would facilitate choosing the best suitable ways of treating patients and would be of great importance for clinical decision-making.
As for advanced gastric cancer, conversion surgery has attracted growing attention. REGATTA trial has failed to demonstrate the survival benefit of reduction surgery for metastatic gastric cancer. However, some study has shown highly selective advanced gastric cancer patients would benefit curative-intent resection after achieving tumor response to chemotherapy. Optimal conversion therapy regimen and optimal time for surgical intervention are a matter of debate.
The goal of this article collection is to focus on the cutting-edge progress in gastric cancer, including translational study, surgical approach, and multidisciplinary management. We welcome the submissions of Review, Mini-Review, and Original Research covering, but not limited to, the following topics:
1) Translational study,
2) Two-dimensional and three-dimensional laparoscopy-assisted or totally laparoscopic gastrectomy,
2) Robot-assisted or totally robotic gastrectomy,
3) Intracorporeal digestive reconstruction after total or subtotal gastrectomy,
4) Functional-preserving surgery for gastric cancer,
5) Multidisciplinary treatment for advanced gastric cancer.
