Surgical trials for gastric cancer

Even though recent progress in gastric cancer therapy has been made in the field of multimodal therapy, surgery is still the mainstay in the curative treatment of this disease. However, a lot of things that have been considered self-evident by the surgical community were or are presently investigated in randomized controlled trials (RCTs). In addition, some RCTs also helped to solve issues that were passionately discussed between Eastern and Western surgeons, like the proper extent of lymphadenectomy. Newer ongoing trials are dealing not only with concepts that aim at the reduction of invasiveness, like the sentinel lymph node concept, minimally invasive or robot surgery but also with the role of surgery and intraperitoneal antitumor agents in advanced gastric cancer. Issues that moved gastric cancer surgeons in recent decades were determined and recent as well as ongoing trials were identified in pertinent registries (ClinicalTrials.gov, WHO International Trials Registry Platform, clinical trials registry of the Japan Clinical Oncology Group) as well as on PubMed. The reader is given an overview of the respective RCTs in the different fields of gastric cancer surgery. Where applicable, older landmark trials are also included in this review. Numerous problems in gastric cancer surgery have already been adequately addressed by RCTs, but there is still plenty of room for future trials in this field in order to generate level-I evidence for generations of oncologic surgeons to come.