Neoadjuvant chemotherapy for locally advanced gastric cancer: the surgeon’s role

In Western countries gastric cancer is commonly diagnosed in locally advanced stages. Although locally advanced gastric cancer is still a potentially curable disease, the prognosis is poor and surgery as first approach does not represent the best option. In order to improve survival, today the management of locally advanced gastric cancer is based on a multimodal treatment, including surgery with extended lymphadenectomy and effective chemotherapeutic schedules. The multimodal approach in gastric cancer aims to provide successful combination and cooperation between surgery and medical treatment: today there is current evidence supporting the use of systemic chemotherapy in a perioperative setting. The role of chemotherapy in gastric cancer is constantly evolving in order to improve outcomes and to reduce therapy-associated toxicity. In this paper we analyze the multidisciplinary approach in the treatment of locally advanced gastric cancer, particularly focusing on the surgeon’s role in this setting.