In this context, perioperative and adjuvant approaches have been developed over the last decades as part of a multimodality treatment in order to decrease local and distant relapses after gastrectomy and improve survival rates. Moreover, even in case of curative resection, the prognosis of patients (pts) with a node positive status at diagnosis remains poor, with five-year survival rates of 20–30%. However, in western countries the mortality remains very high due to the lack of specific screening programs and more than 50% of GC are diagnosed as locally advanced disease, which are not suitable for an upfront curative surgical approach. Surgery with a D2 lymphoadenectomy, removing at least 25 lymph nodes and without macro- or microscopial residual (so-called R0 resection), represents the only curative approach for resectable GC. , The Cancer Genome Atlas (TCGA) work has definitively clarified that the clinical and prognostic differences observed between the intestinal and diffuse GC types have very peculiar molecular bases, with specific clinical implications. In fact, moving from the first histological GC classification provided by Lauren et al. Even if GC was considered a single entity in the past, today it is well-known as a constellation of distinct diseases that can be classified from different points of view, as comprehensively reviewed by Tirino et al. Gastric cancer (GC) represents the fifth-most common tumor and the third-leading cause of cancer-related death worldwide, showing similar trends in Europe.
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