**1. Introduction**

Despite significant reduction in incidence, important advances in understanding of tumour biology and improvements of complex management of this disease, gastric cancer is still a major and in many aspects poorly resolved oncological problem. Thus, the title 'silent killer' still remains.

Gastric cancer is the fourth most common cancer and second leading cause of cancer death in the world, with nearly a million of new cases in 2012 [1]. There are substantial geographical variations in gastric cancer incidence and survival, with half of all cases diagnosed in East Asia (GLOBOCAN data). This is related to the prevalence of risk factors, mainly *Helicobacter pylori* infection (**Table 1**) [2].

Similarly, stage at diagnosis is also dependent on geographical factors and local screening policies. In most countries, the majority of cases are still diagnosed at an advanced stage (see **Figure 1**).

There are many classifications for gastric cancer. Anatomically, it can be divided in true gastric (noncardia) cancers and gastro-oesophageal (cardia) cancers, which differ in epidemiology and surgical treatment [1]. Histologically, the majority of gastric cancers are malignant epithelial tumours, namely, carcinomas (>90%), while neuroendocrine tumours (NETs) and gastrointestinal stromal tumours (GISTs) rank next by frequency [3].

Surgery is still the only potentially curative treatment of gastric cancer. Despite adequate surgical resection, gastric cancer has a high recurrence rate after operation [4]. Survival parameters have traditionally been higher in Asian countries due to screening and higher proportion of early disease [5]. A 5-year overall survival of 72.3% has been reported in one Korean study, whereas European studies report survival of 28.0–44.3% [2]. To improve these figures, a systematic and evidence-based approach must be used to treat gastric cancer.

Since gastric carcinomas, NETs and GISTs have different characteristics, natural history and prognosis, the cornerstone of treatment, surgical resection, has to be adjusted as well. In this chapter, we discuss the common features and differences in surgical treatment of different gastric cancers according to TNM stage as well as the latest advances in minimally invasive and endoscopic surgical techniques.


**Table 1.** Risk factors of gastric cancer.

**Figure 1.** Haematogenous spread of intestinal gastric cancer. Gastrectomy showing a dominant mass lesion. Inset: synchronously resected liver metastasis.
