[The Precised Management of Surgical Treatment for Gastric Cancer: Interpretation of the 5th edition of Japanese Gastric Cancer Treatment Guideline and the 15th edition of Japanese Classification for Gastric Cancer].

The 8(th) UICC gastric cancer TNM classification has international view since it was based on the follow-up data from 57 institutes of 15 countries. The number of examined lymph nodes is a determining factor for accurate staging. Dissection of No13 and No14 nodes may benefit for the selected distal advanced gastric cancer. The concept of esophagogastric junction cancer was redefined and Siewert type Ⅲ EGJ cancer will be classified according to the TNM staging of gastric cancer. The transhiatal approach has survival advantage for patient with esophageal invasion of 3 cm or less EGJ cancer. The dissection of distal lymph nodes for patients with 4 cm or less EGJ cancer is not recommended and the clinical benefit of dissection of lymph nodes in mediastinum is not clear. No10 node dissection is not recommended to the D2 procedure for total gastrectomy. Bursectormy could not bring survival benefits for cT3/4 gastric cancer, nor could palliative surgery bring improved survival to patients with metastatic gastric cancer. However, for highly selected cases of stage Ⅳ gastric cancer, conversion therapy can make some patients get the opportunity of radical operation and gain the chance for long-term survival.