Although PG for upper third GC showed good results in terms of survival, it is associated with an increased mortality rate and a higher risk of reflux esophagitis and anastomotic stricture.

Background and Objectives: Several inflammation markers were found to have a prognostic value in cancer. We investigated the significance of preoperative white cell ratios in determining gastrointestinal stromal tumors (GISTs) outcome. Methods: Clinicopathological features of patients who underwent surgery for GIST were reviewed. The following peripheral blood inflammation markers were calculated: neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), neutrophil-white blood cell ratio (NWR), lymphocytewhite cell ratio (LWR), monocyte-white cell ratio (MWR), and platelet-white cell ratio (PWR). Results: We analyzed 127 patients. Three-and five-year disease-free survival (DFS) were 89.7% and 86.9%, respectively. The univariate analysis selected tumor diameter (P = 0.003), gastric location (P = 0.024), cell type (P = 0.024), mitosis (P < 0.001), MLR (P = 0.014), NLR (P = 0.016), and PLR (P = 0.001) as the factors associated to DFS. The independent prognostic factors for DFS were mitosis (P = 0.001), NLR (P = 0.015), MLR (P = 0.015), and PLR (P = 0.031), with MLR showing the highest statistical significance and hazard ratio (HR) value. MLR, NLR, and PLR were the only prognostic factors in the subgroup of patients with moderate to high Miettinenʼs risk class. A high value of MLR was associated with reduced DFS. Conclusion: MLR, NLR, and PLR are independent prognostic factors for DFS in GISTs.We first demonstrated the role of MLR as a predictor of recurrence in GIST. Its inclusion into clinical management may improve the recurrence estimation.

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The study showed a worse prognosis for transfused patients, but PBTs seem a confounding factor more than a prognostic indicator, as they are obviously affected by other variables.

Between the Ninth International Gastric Cancer Congress (IGCC) in South-Korea (Seoul, 2011) and the Tenth IGCC in Italy (Verona, 2013), the Insubria University organized the First International Course on Upper Gastrointestinal Surgery (Varese, December 2, 2011), with the patronage of Italian Research Group for Gastric Cancer (IRGGC) and the International Gastric Cancer Association (IGCA). The Course was intended to be a comprehensive update and review on advanced gastric cancer (GC) staging and treatment from well-known international experts. Clinical, research, and educational aspects of the surgeon's role in the era of stage-adapted therapy were discussed. As highlighted in the meeting, in this final document we summarize and thoroughly analyze (with references only for well-acquired randomized control trials) the new and old open problems in surgical management of advanced GC. Between the Ninth (Seoul, 2011) and the Tenth (Verona,2013) International Gastric Cancer Congress, the First International Course on Upper Gastrointestinal Surgery (Varese, December 2, 2011) was organized by the University of Insubria. This congress received the patronage of the International Gastric Cancer Association and the Italian Research Group for Gastric Cancer. The aim was to discuss open issues in surgical management of advanced gastric malignancies. We considered the opinions of several recognized experts in the field from both the Eastern and Western world, focused on definition problems and oncological and technical issues to define the current principles of advanced gastric cancer (GC) surgery.

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Nowadays, our understanding of gastric cancer has been improved. The major hope is to increase the survival rates of this aggressive, enigmatic and heterogeneous disease, especially in Western population. Over the past decades, conventional surgery has been the cornerstone of treatment for non metastatic gastric cancer patients. Adequate gastrectomy is recommended for at least T2-4a tumors, while T4b tumors require resection of involved structures. However, in the era of advanced technology, minimally invasive surgical approaches are in the top of the scientific interest. Notably, the laparoscopic approach for gastric cancer is a topic that remain controversial. In this review, we summarize the standard of care according to the current evidences and we provide the latest scientific information assessing safety and efficacy of laparoscopic gastrectomy for gastric cancer.