Skip to main content
. 2019 Mar 19;19(1):1–48. doi: 10.5230/jgc.2019.19.e8

Table 3. Summary of statements.

No. Recommendations Level of evidence Grade of recommendation
Statement 1 Endoscopic resection is recommended for well or moderately differentiated tubular or papillary early gastric cancers meeting the following endoscopic findings: endoscopically estimated tumor size ≤2 cm, endoscopically mucosal cancer, and no ulcer in the tumor. Moderate Strong for
Statement 2 Endoscopic resection could be performed for well or moderately differentiated tubular early gastric cancer or papillary early gastric cancers with the following endoscopic findings: endoscopically estimated tumor size >2 cm, endoscopically mucosal cancer, and no ulcer in the tumor or endoscopically estimated tumor size ≤3 cm, endoscopically mucosal cancer, and ulcer in the tumor. Moderate Weak for
Statement 3 Endoscopic resection could be considered for poorly differentiated tubular or poorly cohesive (including signet-ring cell) early gastric cancers meeting the following endoscopic findings: endoscopically estimated tumor size ≤2 cm, endoscopically mucosal cancer, and no ulcer in the tumor. Low Weak for
Statement 4 After endoscopic resection, additional curative surgery is recommended if the pathologic result is beyond the criteria of the curative endoscopic resection or if lymphovascular or vertical margin invasion is present. Moderate Strong for
Statement 5 Proximal as well as total gastrectomy could be performed for early gastric cancer in terms of survival rate, nutrition, and quality of life. Esophagogastrostomy after proximal gastrectomy can result in more anastomosis-related complications including stenosis and reflux; caution is needed in the selection of reconstruction method. Moderate Weak for
Statement 6 PPG could be performed for early gastric cancer as well as DG in terms of survival rate, nutrition, and quality of life. Moderate Weak for
Statement 7 Gastroduodenostomy and gastrojejunostomy (Roux-en-Y and loop) are recommended after DG in middle and lower gastric cancers. There are no differences in terms of survival, function, and nutrition between the different types of reconstruction. High Strong for
Statement 8 D1+ is recommended during the surgery for early gastric cancer (cT1N0) patients in terms of survival. Low Strong for
Statement 9 Prophylactic splenectomy for splenic hilar LND is not recommended during curative resection for advanced gastric cancer in the proximal third stomach. High Strong against
Statement 10 Lower mediastinal LND could be performed to improve oncologic outcome without increasing postoperative complications for adenocarcinoma of the EGJ. Low Weak for
Statement 11 Laparoscopic surgery is recommended in early gastric cancer for postoperative recovery, complications, quality of life, and long-term survival. High Strong for
Statement 12 Laparoscopic gastrectomy could be performed for advanced gastric cancer in terms of short-term surgical outcomes and long-term prognosis. Moderate Weak for
Statement 13 Adjuvant chemotherapy (S-1 or capecitabine plus oxaliplatin) is recommended in patients with pathological stage II or III gastric cancer after curative surgery with D2 LND. High Strong for
Statement 14 Adjuvant chemoradiation could be added in gastric cancer patients after curative resection with D2 lymphadenectomy to reduce recurrence and improve survival. High Weak for
Statement 15 Neoadjuvant chemotherapy for potentially resectable gastric cancer is not conclusive if D2 LND is considered. High Inconclusive
Statement 16 The evidence for the effectiveness of neoadjuvant chemoradiation in locally advanced gastric cancer is not conclusive if D2 LND is considered. High Inconclusive
Statement 17 Palliative gastrectomy is not recommended for metastatic gastric cancer except for palliation of symptoms. High Strong against
Statement 18-1 Palliative first-line combination platinum/fluoropyrimidine is recommended in patients with locally advanced unresectable or metastatic gastric cancer if the patient's performance status and major organ functions are preserved. High Strong for
Statement 18-2 Palliative trastuzumab combined with capecitabine or fluorouracil plus cisplatin is recommended in patients with HER2 IHC 3+ or IHC 2+ and ISH-positive advanced gastric cancer. High Strong for
Statement 19 Palliative second-line systemic therapy is recommended in patients with locally advanced unresectable or metastatic gastric cancer if the patient's performance status and major organ functions are preserved. Ramucirumab plus paclitaxel is preferably recommended and monotherapy with irinotecan, docetaxel, paclitaxel, or ramucirumab could also be considered. High Strong for
Statement 20 Palliative third-line systemic therapy is recommended in patients with locally advanced unresectable or metastatic gastric cancer if the patient's performance status and major organ functions are preserved. High Strong for
Statement 21 Palliative RT could be offered to alleviate symptoms and/or improve survival in recurrent or metastatic gastric cancer. Moderate Weak for
Statement 22 Peritoneal washing cytology is recommended for staging. Advanced gastric cancer patients with positive cancer cells in the peritoneal washing cytology are associated with frequent cancer recurrence and a poor prognosis. Moderate Strong for

PPG = preserving gastrectomy; DG = distal gastrectomy; LND = lymph node dissection; EGJ = esophagogastric junction; IHC = immunohistochemistry; ISH = in situ hybridization; RT = radiotherapy.

HHS Vulnerability Disclosure