الفهرس 
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Abstract
Gastric cancer occupies the fourth position in the incidence of malignancy and the eighth leading cause of death from cancer. Patient with gastric cancer very often present with an advanced stage or even disseminated disease at the time of admission. The prognosis is generally considered poor but survival is closely related to the TNM-stage.Upper gastrointestinal cancer spreads rapidly, especially to the loco regional lymph nodes and by trans coelomic root to the peritoneal cavity. Peritoneal and other metastatic spreads are crucial prognostic factors in upper gastrointestinal cancer as no cure is possible and patint survival is limited.The conventional methods for this staging procedure are chest X-ray, trans abdominal ultrasonography (US), angiography, and CT or MRI scanning. These methods are insufficient especially due to a low sensitivity in the pre therapeutic identification of local non respectability and in some cases of distant metastasis.Endoscopy allows direct visualization of tumor location, the extent of mucosal involvement, and biopsy for tissue diagnosis . EUS is currently the most valuable diagnostic tool for preoperative staging of gastric cancer. It can maximize tumor staging by providing information about depth of tumor invasion and assess the extent of perigastric lymphadenopathy.The benefit of laparoscopy in staging localized gastric cancer patients is well established. Laparoscopy is recommended as a standard preoperative staging procedure, because it can spare patients unnecessary laparotomy in those with radiologically occult metastatic disease.Endoscopic resection of EGC is well established as a standard therapy in Japan and is increasingly becoming accepted and regularly used in other countries. ESD , a modification of EMR , has been developed to allow the resection of larger lesions in an en-bloc manner and the results are encouraging .
Radical surgical resection is the only curative treatment for patients with gastric cancer and is the first choice treatment in patients with early stages. The role of neo adjuvant chemotherapy has been recently suggested for patients with locally advanced disease so as to down stage.However its roles and its benefits are still being evaluated with different combinations in several clinical triads. Careful selection is important in the surgical management of gastric cancer which is usually based mainly on both the patient and the tumor characteristics. Accurate preoperative staging is vital to patient selection for treatment.
Laparoscopy-assisted distal gatrectomy (LADG) is a relatively new treatment for gastric cancers that has received considerable attention for its minimal invasiveness and post operative out come compared to open surgery.Robotic-assisted gastrectomy (RAG) is a new procedure for management of gastric carcinoma But it was found that robotic-assisted gastrectomy performed by an experienced surgeon resulted in similar post operative outcomes and complications to those of (LAG).Early detection of gastric cancer is vital. Whereas advanced gastric cancer has a poor prognosis, early gastric cancer (EGC) represents a potentially curable stage in the natural history of the disease. Gastrectomy with lymph node dissection in particular has provided an excellent therapeutic outcome for EGC, achieving 5- year survival rates higher than 90%.