Gastric cancer is the fourth most common cancer worldwide and the second leading cause of cancer death. The highest incidence of gastric cancer is in Eastern Asia. China has 463,000 new cases a year, whereas the United States as an annual incidence of 21,000 cases . Intestinal type gastric cancer is more prevalent in high-risk areas and is influenced by environmental factors. Because the incidence and histology are variable by region, there remains significant worldwide controversy regarding management of the disease.