The New Era of Gastric Cancer in the East and West: Have Our Approaches Harmonized?

gical oncologists to understand the importance of a D2 lymphadenectomy as a superior approach to D1 [7] . In the East, the Japanese randomized control trial of D3 versus D2 lymphadenectomy demonstrated that a D2 resection affords similar disease-specific survival with less morbidity. It appears that on this topic, the East and West have finally harmonized [8] . From a technical perspective, both the East and West have applied technologic advances to minimally invasive approaches for selected patients with gastric cancer. The East has blazed this trial. For example, with their unique and large cohort of early gastric cancer patients, they have rigorously evaluated approaches such as endoscopic mucosal resection for early gastric cancer. In their comprehensive and illuminating chapter, Dr. Yang and Dr. Lee [pp. 132–141] elegantly summarize significant advances in application of minimally invasive approaches to gastric cancer resection. The laparoscopic approach to gastrectomy has been led by surgeons from the Eastern hemisphere, where the increased incidence of gastric cancer and earlier-stage disease predominate. The randomized controlled trials (mostly from the East) outlined by Dr. Yang and Dr. Lee, established this approach as feasible, safe, and oncologically sound. They outline and discuss the many randomized prospective studies that have been completed for the purpose of assuring the safety and efficacy of this treatment approach. It is interesting that few areas have accumulated so many evidence-based In this special issue of Digestive Surgery on gastric cancer, authorities from around the world have contributed to this comprehensive compendium that highlights and summarizes our current understanding. Differences in disease-specific survival of gastric cancer patients endemic to the Eastern hemisphere compared to the Western hemisphere have, unfortunately, historically encouraged a division of thinking and approaches to treatment for a disease that may be more similar than previously thought. Many practice-changing advances have been made just in the past few years – the field is dynamic. Contributions include improvements in staging and treatment that have been of significant impact in the East and West. For one, neoadjuvant treatment approaches for locally advanced gastric tumors have improved survival and changed clinical practice such as outlined by the MAGIC trial, which evaluated perioperative chemotherapy with epirubicin, cisplatin, and 5-fluorouracil to surgery alone and demonstrated a significant survival benefit with perioperative chemotherapy [1] . A combination of both novel and effective adjuvant treatment regimens from the West and East have further expanded treatment options to adjuvant chemotherapy combinations [2] , chemotherapy + radiation [3, 4] , or single-agent adjuvant therapy [5, 6] to name just a few. Similarly, the East and West have begun to resolve differences on the long-debated topic of lymphadenectomy. In the West, the updated Dutch trial has led Western surPublished online: July 18, 2013