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Gastric carcinoma is the fourth most common cancer (988 000 cases in 2008) and the second leading cause of cancer death in both sexes worldwide (736 000 deaths in 2008).1 These unfavourable mortality data are related to the non-specific clinical presentation of the disease and, hence, a delayed diagnosis. The high incidence of this tumour justifies the use of cancer-specific screening programmes only in Eastern countries, while this is not cost effective for the rest of the world: this explains why in Japan and South Korea the diffusion of endoscopy has allowed to identify almost 50% of cancers at early stages (ie, T1 tumours).2 Conversely, in Western countries, more than two-thirds of gastric tumours are found in advanced stages;3 indeed, most of these patients have a locally advanced resectable disease.
Several robust studies demonstrated that locally advanced cancer benefits from multimodal treatment other than surgery alone4 ,5 and patients’ selection for a stage-adapted therapy should be based on a clinical estimation of pathological TN (M0) stage. Even if …
Contributors SR: Study concepts. SR, LB: Manuscript preparation. FR: Manuscript editing. GD: Manuscript review.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.