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. 2023 Dec 31;44(1):127–172. doi: 10.1002/cac2.12516
Clinical staging* Stratification Grade I recommendations** Grade II recommendations Grade III recommendations
I cT1aN0M0 Patients not suitable for EMR/ESD D1 gastrectomy (Evidence 1A)
cT1bN0M0 Patients suitable for surgery D1 gastrectomy (differentiated type, <1.5 cm) or D1+ gastrectomy (other indications) (Evidence 1A)
cT2N0M0 Patients suitable for surgery D2 gastrectomy (Evidence 1A)
II

cT1‐2N1‐3M0

cT3‐4N0M0

 Non‐EGJ cancer and patients suitable for surgery D2 gastrectomy (Evidence 1A) + adjuvant chemotherapy (Evidence 1A)
EGJ cancer and patients suitable for surgery

  • Neoadjuvant chemotherapy + D2 gastrectomy + adjuvant chemotherapy, (Evidence 1B)

  • Neoadjuvant chemoradiotherapy + D2 gastrectomy + adjuvant chemotherapy, (Evidence 1B)

 D2 gastrectomy (Evidence 1A) + adjuvant chemotherapy (Evidence 1B)
III

cT3‐4aN1‐3M0

 Non‐EGJ cancer and patients suitable for surgery

  • D2 gastrectomy (Evidence 1A) + adjuvant chemotherapy, (Evidence 1A)

  • Laparoscopic exploration, (Evidence 1B)

  • Neoadjuvant chemotherapy + D2 gastrectomy + adjuvant chemotherapy (Evidence 1A)
EGJ cancer and patients suitable for surgery

  • Laparoscopic exploration, (Evidence 1B)

  • Neoadjuvant chemotherapy + D2 gastrectomy + adjuvant chemotherapy (Evidence 1A)

  • Neoadjuvant chemoradiotherapy + D2 gastrectomy + adjuvant chemotherapy (Evidence 1B)

 D2 gastrectomy (Evidence 1A) + adjuvant chemotherapy (Evidence 1B)
IVA cT4bN0‐3M0 Cases with no unresectable factors MDT discussion for the optimal personalized management

  • Laparoscopic exploration (Evidence 1B)

  • Neoadjuvant chemotherapy + gastrectomy (combined organ resection) + adjuvant chemotherapy (Evidence 2A)

  • Neoadjuvant chemoradiotherapy + gastrectomy (combined organ resection) + adjuvant chemotherapy (Evidence 2B)

 Encourage participation in clinical trials

Abbreviations: cTNM, clinical tumor‐node‐metastasis; EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection; EGJ, esophagogastric junction.

*

The 8th edition of the AJCC/UICC clinical staging system (cTNM).

**

Laparoscopic surgery may serve as an alternative to open surgery for distal gastrectomy in early and advanced gastric cancer, as well as for total gastrectomy in early gastric cancer.