Exploration of surgical decision-making for gastric cancer in the era of immunotherapy
10.3760/cma.j.cn115396-20250413-0009
- VernacularTitle:免疫治疗时代胃癌手术决策探讨
- Author:
Jianxin CUI
1
;
Rui LI
;
Hao CUI
;
Lin CHEN
Author Information
1. 解放军总医院第一医学中心普通外科医学部，北京 100853
- Keywords:
Stomach neoplasms;
Neoadjuvant therapy;
Immunotherapy;
Minimally invasive surgical procedures;
Function-preserving
- From:
International Journal of Surgery
2025;52(5):289-295
- CountryChina
- Language:Chinese
-
Abstract:
The introduction of immunotherapy has significantly improved the pathological complete response (pCR) rate and tumor downstaging effect in patients receiving neoadjuvant therapy for gastric cancer, while simultaneously presenting new challenges and opportunities for surgical decision-making. The recommended number of cycles for neoadjuvant therapy is 2 to 4 cycles, and the recommended time interval for surgery is within 4 to 6 weeks after the last treatment. Laparoscopic and robotic-assisted minimally invasive surgeries have demonstrated relative advantages in postoperative recovery and safety. For cases achieving pCR or significant tumor regression after immunotherapy, active function-preserving surgeries or enrollment in clinical trial cohorts may be explored. Basic research indicates that preserving unaffected lymph nodes may maintain immune activity, challenging the traditional D2 lymphadenectomy scope, which requires further clinical evidence. Neoadjuvant immunotherapy has not significantly increased perioperative complications. This article aims to discuss the core issues in surgical decision-making for gastric cancer after neoadjuvant therapy, providing a detailed analysis from the perspectives of surgical timing, approach, scope, and complication management, with the hope of offering more references for surgical decision-making after neoadjuvant therapy.
