Western perspective and epidemiology of gastric cancer

Gastric cancer incidence is five to tenfold higher in Eastern countries with respect to Europe and North America. Hence, Eastern surgeons got the opportunity to gain a remarkable surgical experience in high-volume series. Recently, also in the West, specialized surgical centres managed to achieve good short-term results, close to those recorded in Eastern series. However, long-term survival in Western series is still lagging behind survival recorded in Eastern series. Of note, Western patients usually present more aggressive forms, such as Helicobacter pylori negative proximal or diffuse subtypes, in particular signet ring cell (SRC). Moreover, Eastern patients are often diagnosed at an earlier stage due to mass screening programs. Hopefully, we will witness further improvements in gastric cancer management in the next years.