Essential updates 2019/2020: Perioperative and surgical management of gastric cancer

Perioperative and surgical management of gastric cancer have been changing as pivotal phase II trials and landmark phase III trials offer new insights to the existing knowledge. The results of many landmark trials have been published or presented in the past year, many of which have changed or will change current clinical practice. For example, FLOT4 has completely changed the regimen of perioperative chemotherapy in Europe. Furthermore, evidence for minimally invasive surgery for clinical Stage I was firmly established by KLASS‐01 and JCOG0912 for distal gastrectomy and CLASS‐02, KLASS‐03, and JCOG1401 for total gastrectomy. Moreover, promising results were provided by CLASS‐01 and KLASS‐02 for locally advanced gastric cancer. For adjuvant chemotherapy, JACCRO GC‐07 (START‐2) has provided a new doublet regimen for pathological Stage III, which is often refractory to chemotherapy. Conversely, JCOG0501 poses a significant challenge for advanced tumors, such as large type 3 and scirrhous (type 4) tumors. In this review, we briefly review recent updates and discuss future perspectives of gastric cancer treatment.