Gastric cancer is the second most common cancer world-wide, with a frequency that varies greatly across different geographic locations . Its incidence is higher in southern and Eastern Europe; in Italy there are 22.1 new cases/100,000 males and 11.2 cases/100,000 females annually. Gastric cancer is rare before the age of 40, and its incidence peaks in the seventh decade of life. In recent decades the survival rate for gastric cancer has improved in countries such as Japan , but in Western countries in patients resected with curative intent the recurrence rate is 40 to 65%  and the overall 5-year survival rate is 30% [4, 5]. Differences in the incidence and overall survival of gastric cancer suggest ethnic origin as a possible risk factor , but environmental, dietary and behavioral factors may be more relevant than ethnicity with the generation of carcinogenic N-nitroso compounds, while the influence of smoking and alcohol consumption has not been completely clarified . An important development in the epidemiology of gastric carcinoma has been the recognition of the association with Helicobacter pylori infection: early infection induces changes in the gastric mucosa with progression to gastric atrophy and intestinal metaplasia predisposing the patient to the development of carcinoma and reducing the risk of duodenal ulcer due to the decreased acid production associated with gastritis. In patients with late Helicobacter pylori infection, atrophic gastritis is less frequently observed and therefore the risk of gastric cancer is lower , while, in patients with long-lasting reflux disease, antisecretory drugs and eradication of Helicobacter pylori infection  could increase the incidence of cancer of the gastric cardia .
KeywordsGastric Cancer Total Gastrectomy Intestinal Metaplasia Atrophic Gastritis Subtotal Gastrectomy
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