Complete surgical resection remains the primary curative treatment option for patients with early stage gastric adenocarcinoma appropriately staged with an adequate lymphadenectomy. Unfortunately, only 40% patients who undergo curative resection at the authors' institution will have early stage (i.e., stage IA or T2N0M0) disease; thus, the majority of patients will remain at high risk for recurrence after complete resection. At present, the authors advocate rigorous preoperative staging studies to identify patients with high-risk gastric cancer who are unlikely to benefit from single modality therapy, namely surgery alone, and assign them to undergo neoadjuvant chemotherapy before an attempt at curative resection. Patients who are determined to have high-risk disease postoperatively should be offered adjuvant therapy that will address the site of recurrence most likely to affect survival.
