Tumor stage, growth pattern and tumor site are major factors determining the extent of resection and lymphadenectomy. In patients with early tumor stages, anatomically orientated limited resection techniques are increasingly important, probably in combination with the concept of the sentinel lymph node. Gastric cancer staged uT1sm/2 is treated with surgery alone. Proximal tumors undergo a transhiatal extended gastrectomy, tumors in the middle third a total gastrectomy and distal tumors a subtotal gastrectomy, if possible. In locally advanced tumors perioperative chemotherapy improves prognosis and is now standard in the western world. D2 lymphadenectomy is now accepted as standard procedure, providing improved prognosis for certain subgroups of patients. Individualized resection and lymphadenectomy techniques for early tumor stages and response based neoadjuvant concepts for locally advanced tumors are the challenge of the future.