“The sixth edition of the Japanese Gastric Cancer Treatment Guidelines was completed in July 2021, incorporating new evidence that emerged after publication of the previous edition. It consists of a text-based “Treatments” part and a “Clinical Questions” part including recommendations and explanations for clinical questions. The treatments parts include a comprehensive description regarding surgery, endoscopic resection and chemotherapy for gastric cancer. The clinical question part is based on the literature search and evaluation by an independent systematic review team.”

“The major points of revision in the current edition are listed below:

1. The number of CQs has increased to 32 items, including surgery, endoscopic therapy, chemotherapy, and palliative therapy.
2. Based on the results of the prospective study jointly conducted by JGCA and the Japan Esophageal Society, an algorithm of the surgical approach and lymph node dissection for cT2–T4 has been shown. Additionally, three CQs for esophagogastric junctional carcinoma have been proposed, and recommendations for them are provided.
3. Recommendations for laparoscopic surgery and robot-assisted surgery based on the latest research results were provided.
4. Chemotherapeutic regimens to treat unresectable advanced or recurrent gastric cancer patients have been classified into either the “recommended regimens” or “conditionally recommended regimens” as algorithms in the “Treatments” part. The evidence level as defined in the MINDS manual ver. 2 was provided for all regimens classified into the “recommended regimens” category. Though treatment options increased, evidences generated by direct comparisons between each regimen do not exist. Therefore, no priorities have been given, and evidence levels have not been listed.
5. The latest research results of immune checkpoint inhibitors have been explained in CQ23.”

Japanese Gastric Cancer Association. “Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition).” Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association vol. 26,1 (2023): 1-25. Free Full Text