Explanation of the 7 Clinical Questions in Japanese Gastric Cancer Treatment Guidelines of Version 4

Surgery is the main treatment for curing gastric cancer, standard D2 gastrectomy and systematical therapy provides an excellent survival outcome in East Asian countries, especially Japan, Korea, and China, however, there are many clinical questions still under debate for a long time. Japanese gastric cancer treatment guidelines has produced a great effect on the surgical treatment of gastric cancer. The treatment of gastric cancer is more standardized, rationalized and normalized. In recent years, new research results made the guideline revised. The 4th Edition of 2014 has proposed a solution for Stage IV patients with single non-curative factors. Patients with No.16a2, b1 lymphnodes metastasis, liver metastasis, or with peritoneal metastasis/CY1 disease are scheduled to receive combined treatment of operation and chemotherapy. The 4th edition incorporated new evidence that includes those delivered as a quick bulletin in the website of the Japan Gastric Cancer Association after publication of the previous version. It remains largely conformed to the textbook style, but a new section has summarized 7 clinical questions to address some important clinical issues for which hard evidence is unavailable. These questions makes the basic principles for the treatment of gastric cancer and the concept more scientific and accurate. It will provide important guidance for the future clinical practice. We provided additional comments and deeply interpreted the questions proposed by the guideline according to some new research and our clinical experience.