Over the past 30 years, numerous major centers have published analyses of potential factors influencing survival following resection of gastric cancer. The independent significance of depth of tumor penetration and lymph node status has been consistently documented. With proper staging, we know which patients are most likely to die of their disease. Unfortunately, adjuvant treatment in surgical resection has not altered patient outcome. Emphasis should now be on selecting the patients who should receive radical surgery for cure, adjuvant therapy with a hope for cure, or palliation. This brief review concentrates on recent developments in our ability to stage patients preoperatively, developments that may change the way we approach the patient with stomach cancer in the future.