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Laparoscopic surgery for gastric carcinoma has been shown to be potentially superior to traditional laparotomy with regard to short-term benefits. The technique seems safe and capable of fulfilling oncological criteria for cancer surgery. However, questions regarding recurrence rates and long-term survival have not yet been satisfactorily answered. Further follow-up and a review of large, multicenter randomized trials are needed before widespread acceptance of the technique can be recommended. Finally, surgeons with sufficient expertise and ongoing peer-reviewed data collection may currently offer this therapy to appropriately selected patients.

Older-generation regimens against advanced gastric cancer have limited efficacy. No standard regimens worldwide, as well as in Japan, have been established yet, and a limited number of patients have achieved objective response and long-term survival. However, some of the new-generation regimens improved response rate more than 50% and suggested survival prolongation in the preliminary studies. These treatments are being investigated in ongoing randomized studies in Japan, and we should wait for the results to confirm these improvements. Recent development of molecular technology has produced various types of molecular targeting agents. These agents are the other new hopes for improving efficacy results with less toxicity than classic cytotoxic agents. Understanding the biology of gastric cancer may result in better targets or cellular pathways to be modified or blocked by therapeutic interventions. Additionally, improvement of the clinical trial design and molecular surrogate in clinical research will lead to the development of better treatments. Both clinical and biology research will be more important.

An update regarding the significance of adjuvant chemotherapy for the treatment of gastric cancer has been described. The structure and anticancer mechanism of drugs used during adjuvant chemotherapy against gastric carcinoma are also described. Recent advances in cancer chemotherapy and molecular targeting therapy are promising, and it is believed that these advances will provide improvements in the prognosis of advanced gastric carcinoma. Well-designed RCTs are mandatory to obtain quality evidence for adjuvant chemotherapy against gastric carcinoma.

The SN concept in gastric cancer treatment appears ready to assume several important roles in the individualization of treatment in patients with gastric cancer, especially early gastric cancer. The coming decade is likely to see broad general acceptance of minimally invasive and function-preserving surgery based on the sensitive prediction of LN metastasis by SN biopsy.