Cure can be achieved if the malignant cells are limited to the gastric mucosa and submucosa,this is called early gastric cancer,it is well known in Japan,to lesser extent in South America. It is rarely encountered in Europe,North America,and the rest of the world. The Japanese constantly reporting 10 years survival rate up to 98% in several reports after R0 resection.
Once the malignant cells break through the muscularis mucosa to reach muscularis propria,it is now an advanced gastric cancer,it have a different morphological appearance,it is the gastric cancer we all see and treat.The 5 years survival drops to 50% with R0 resection. If malignant cells reached the lymph nodes the 5 years survival will have another drop to 20%.Putting in mind that about 60% of all gastric cancer when we first see have already lymph node metastasis,this make a collective 5 years survival in the range of 25-35%,and this have been constant for the last 100 years.
You for the above reasons let us talk about palliation,and forget about cure as you might not get it even in the smallest malignant ulcers with no macroscopic lymph node involvement.Palliation means excision of the tumor en bloc with lymph nodes,and any infiltrated organ[pancreas,spleen,colon,part of the liver]cutting through NORMAL TISSUE and getting a macroscopically surgical free margin from 5 to 8 cm. Cutting through malignant tissue is contraindicated as local recurrence is very rapid and is one of the worse complications.
A constant documented observation is that the large locally advanced tumors with adjacent lymph node involvement,with or without other organ involvement,when resected [This is the case of our Chinese friend.]do better than small tumors with multi group lymph node involvement.
We are not fishing for mistakes,we are freely discussing what is the best option in this particular clinical situation. Surgery is the only hope for gastric cancer,and resection(if possible) is the best palliation. It was important to clarify this particular point to the large number of surgeons on for-surgeons.com as the diagnosis of cancer of the stomach often signifies impending death,even among medical profession there is widespread belief that this diagnosis implies hopelessness.