Treatment of gastric cancer in Germany

The first German guideline on diagnosis and treatment of gastric cancer founded upon evidence-based and expert consensus. Due to increasing incidence junctional tumors were included and can be best classified in subgroups I-III described by Siewert. Among staging procedures endosonography should added to computed tomography of the chest and abdomen. Laparoscopy is optional in advanced tumor stages. Mucosal cancer should be resected "en bloc" endoscopically. Primary surgical resection is indicated in category u1b/2. The extent of gastrectomy depends on localization and histomorphological (Lauren) type of the tumor and includes subtotal distal as well as (extended) total gastrectomy. Proximal gastrectomy is only recommended as Merendino procedure in early adenocarcinomas of the distal esophagus. In curative intent D2-lymphadenectomy is the procedure of choice nowadays. For locally advanced gastric carcinomas (>uT3N+) perioperative chemotherapy shall be carried out whereas in AEG tumors of type II/III radio-chemotherapy is an alternative option. After R1/2-resection curative reoperation has to be considered otherwise radio-chemotherapy should be performed. The value of palliative gastrectomy is still under discussion and depends on the symptoms of the patient and/or on the availability of effective interventional procedures. The actual German guideline represents an up-to-date recommendation of diagnostic, staging and therapeutic standards in gastric cancer and must be revised and adapted to the developments and improvements in the future continuously.