Recent advances in tumor immunology have made immunotherapy a new direction for neoadjuvant treatment of gastric cancer. Multiple clinical trials have confirmed that combining immunotherapy with chemotherapy and targeted therapy in the neoadjuvant treatment of gastric cancer can effectively improve treatment response and prolong patient survival time. This article aims to comment on the application of immunotherapy in the neoadjuvant treatment of gastric cancer, exploring its mechanisms, integration strategies with traditional treatments, safety, and personalized precision therapy in the hope of providing new insights and directions for the field of gastric cancer treatment.

Recent advances in tumor immunology have made immunotherapy a new direction for neoadjuvant treatment of gastric cancer. Multiple clinical trials have confirmed that combining immunotherapy with chemotherapy and targeted therapy in the neoadjuvant treatment of gastric cancer can effectively improve treatment response and prolong patient survival time. This article aims to comment on the application of immunotherapy in the neoadjuvant treatment of gastric cancer, exploring its mechanisms, integration strategies with traditional treatments, safety, and personalized precision therapy in the hope of providing new insights and directions for the field of gastric cancer treatment.

Gastric mixed adenoneuroendocrine carcinomas(G-MANEC)are an infrequent variant of gastrointestinal tumors.Despite their relatively low occurrence,there has been a noticeable upward trend.G-MANEC exhibit a highly invasive nature,frequently leading to lymph-atic and distant metastases,which ultimately result in unfavorable prognosis.Consequently,this condition has garnered considerable in-terest among researchers.G-MANEC are characterized by the presence of adenocarcinoma and neuroendocrine carcinoma components,with each component comprising at least 30%of the tumor.In recent years,a growing body of knowledge regarding G-MANEC has led to a more comprehensive research approach towards this type of carcinoma.Nevertheless,there has been a notable deficiency to date in the ex-amination of lymph node metastatic aspects of G-MANEC,which poses several pressing challenges that demand immediate resolutions.This review aims to systematically analyze previous case reports and studies on mixed neuroendocrine-non-neuroendocrine neoplasms(MiNEN)while incorporating research on gastric cancer.This study focuses on various aspects of G-MANEC,including the epidemiology,biological ori-gin,diagnosis,patterns of lymph node metastasis,relationship with hematogenous metastasis,association between lymphatic and distant metastases,and treatment.The objective is to offer guidance for future research endeavors concerning G-MANEC.

Purpose: The aim of the present study was to compare the difference between double tract reconstruction and esophagogastrostomy. Materials and Methods: Patients who underwent radical proximal gastrectomy with esophagogastrostomy or double tract reconstruction were included in this study. Results: Sixty-four patients were included in this study and divided into two groups according to reconstruction method. The two groups were well balanced in perioperative safety and 3-year overall survival (OS). The rates of postoperative reflux esophagitis in the double tract reconstruction group and esophagogastrostomy group were 8.0% and 30.8%, respectively (p=0.032). Patients in the double tract reconstruction group had a better global health status (p < 0.001) and emotional functioning (p < 0.001), and complained less about nausea and vomiting (p < 0.001), pain (p=0.039), insomnia (p=0.003), and appetite loss (p < 0.001) based on the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire. Regarding the EORTC QLQ-STO22 questionnaire, patients in the double tract reconstruction group complained less about dysphagia (p=0.030), pain (p=0.008), reflux (p < 0.001), eating (p < 0.001), anxiety (p < 0.001), dry mouth (p=0.007), and taste (p=0.001). The multiple linear regression analysis showed that reconstruction method, postoperative complications, reflux esophagitis, and operation duration had a linear relationship with the global health status score. Conclusion Double tract reconstruction could better prevent reflux esophagitis and improve quality of life without scarifying perioperative safety or 3-year OS.

Purpose: Gastric cancer (GC) has substantial biological differences between Asian and non-Asian populations, which makes it difficult to have a unified predictive measure for all people. We aimed to identify novel prognostic biomarkers to help predict the prognosis of Asian GC patients. Materials and Methods: We investigated the differential gene expression between GC and normal tissues of GSE66229. Univariate, multivariate and Lasso Cox regression analyses were conducted to establish a four-gene-related prognostic model based on the risk score. The risk score was based on a linear combination of the expression levels of individual genes multiplied by their multivariate Cox regression coefficients. Validation of the prognostic model was conducted using The Cancer Genome Atlas (TCGA) database. A nomogram containing clinical characteristics and the prognostic model was established to predict the prognosis of Asian GC patients. Results: Four genes (RBPMS2, RGN, PLEKHS1, and CT83) were selected to establish the prognostic model, and it was validated in the TCGA Asian cohort. Receiver operating characteristic analysis confirmed the sensitivity and specificity of the prognostic model. Based on the prognostic model, a nomogram containing clinical characteristics and the prognostic model was established, and Harrell’s concordance index of the nomogram for evaluating the overall survival significantly higher than the model only focuses on the pathologic stage (0.74 vs. 0.64, p < 0.001). Conclusion The four-gene-related prognostic model and the nomogram based on it are reliable tools for predicting the overall survival of Asian GC patients.

Purpose: The aim of the present study was to compare the difference between double tract reconstruction and esophagogastrostomy. Materials and Methods: Patients who underwent radical proximal gastrectomy with esophagogastrostomy or double tract reconstruction were included in this study. Results: Sixty-four patients were included in this study and divided into two groups according to reconstruction method. The two groups were well balanced in perioperative safety and 3-year overall survival (OS). The rates of postoperative reflux esophagitis in the double tract reconstruction group and esophagogastrostomy group were 8.0% and 30.8%, respectively (p=0.032). Patients in the double tract reconstruction group had a better global health status (p < 0.001) and emotional functioning (p < 0.001), and complained less about nausea and vomiting (p < 0.001), pain (p=0.039), insomnia (p=0.003), and appetite loss (p < 0.001) based on the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire. Regarding the EORTC QLQ-STO22 questionnaire, patients in the double tract reconstruction group complained less about dysphagia (p=0.030), pain (p=0.008), reflux (p < 0.001), eating (p < 0.001), anxiety (p < 0.001), dry mouth (p=0.007), and taste (p=0.001). The multiple linear regression analysis showed that reconstruction method, postoperative complications, reflux esophagitis, and operation duration had a linear relationship with the global health status score. Conclusion Double tract reconstruction could better prevent reflux esophagitis and improve quality of life without scarifying perioperative safety or 3-year OS.

With the approaches of artificial intelligence and big data, the development of cancer genomics and updating of imaging technology, gastric cancer surgery is facing great challenges and opportunities. The main focus is on laparoscopic surgery technology, enhanced recovery after surgery, multidisciplinary comprehensive treatment, and precision medicine. Considering the common de-mand for reduced complication rate among doctors and patients, laparoscopic surgery has become widely popular owing to its advan-tages of small incision and rapid recovery. Furthermore, the development of artificial intelligence and big data has raised a new chal-lenge in routine diagnosis and treatment. As a result, we encourage multicenter cooperation, and data standardization and sharing. At present, completion of the transition from empirical medicine to evidence-based medicine and promotion of the individualization and standardization of gastric cancer treatment are needed.

Synchronous multiple gastric cancer is a rare condition involving multiple malignant tumors at different sites in the stom-ach. Such cases account for 6%-14% of all gastric cancers. Currently, cases of multiple gastric cancer can be classified by the monoclo-nal or polyclonal nature of the original tumor. Some patients with multiple gastric cancer exhibit hereditary susceptibility and muta-tions in mismatch repair genes. Multiple gastric cancer occurs more commonly among elderly male patients and in the proximal stom-ach at an early stage. No significant differences in vascular invasion, differentiation status, and lymph node metastasis have been iden-tified between solitary and multiple gastric cancers. Several treatment approaches for multiple gastric cancer have been applied clini-cally, including endoscopic resection and subtotal and total gastric resection according to the tumor stages and sites. Further discus-sion is needed regarding the extension of gastric resection for multiple gastric cancer in patients with hereditary susceptibility.

OBJECTIVETo explore the risk factors of pulmonary infection after D2 radical gastrectomy of gastric cancer in order to guide clinical measures to reduce the incidence of pulmonary infection.

METHODSClinical data of 371 patients undergoing D2 radical gastrectomy at Division 2 of Gastrointestinal Cancer Center from October 2014 to October 2016 were collected for retrospective cohort study. Associated risk factors of pulmonary infection after D2 radical gastrectomy of gastric cancer were analyzed. Diagnosis criteria of pulmonary infection: occurrence of new pulmonary rales; new infiltrative change or consolidation in chest by imaging examination; with at least one of the following: temperature ≥38.5centi-degree, emergence of new purulent sputum or sputum character change, isolated pathogens from bronchial brush biopsy or tracheal secretion culture.

RESULTSOf 371 patients, 265 were males and 106 were females. The average age was 59.1(22-80) years old. There were 38(10.2%) cases of pulmonary infection after radical resection of gastric cancer. Univariate analysis showed that smoking history, intra-operative blood loss ≥200 ml, total gastrectomy, and gastric intubation ≥6 d were associated with pulmonary infection after D2 radical gastrectomy (all P<0.05). Six cases quitted smoking 2 weeks before operation with pulmonary infection incidence of 8.1%(6/74), and 16 patients did not quit smoking 2 weeks before operation with pulmonary infection incidence of 21.1%(16/76), and the difference was statistically significant (χ=4.0387, P=0.0445). Multivariate Logistic regression analysis showed that postoperative gastric intubation ≥6 d (OR=4.335, 95%CI: 1.088 to 4.586, P=0.05), smoking history (OR=3.469, 95%CI: 1.056 to 5.252, P=0.043) and intra-operative blood loss ≥200 ml (OR=3.931, 95%CI: 1.350 to 10.574, P=0.013) were independent risk factors of pulmonary infection after D2 radical gastrectomy of gastric cancer.

CONCLUSIONFor gastric cancer patients undergoing D2 radical gastrtectomy with smoking history, greater blood loss during operation and postoperative gastric intubation ≥6 d, surgeons must pay attention to the prevention of postoperative pulmonary infection.

Objective To investigate the clinical effects of gastrointestinal decompression with enteral feeding tube in elderly patients with gastric cancer.Methods 78 cases of gastric cancer patients undergoing postoperative gastric decompression with enteral feeding tube were selected as the treatment group,and 66 patients with gastric cancer undergoing postoperative intravenous nutrition and gastric decompression with routine nasogastric tube as the control group in our hospital from January 2015 to December 2015.The incidence rate of gastric tube patency,faster postoperative recovery,nutritional immune improvement,adverse reaction and complication were compared between the two groups.Results The incidence rate of adverse reactions and complications in treatment group were significant lower than in control group (3.0 ％ vs.12.8 ％,x2 =4.4857,P =0.0342;1.5 ％ vs.10.2％,x2 =4.6620,P =0.0308,respectively).Following parameters were significant better in treatment group versus in control group:the time of evacuating [(3.1 ± 0.3) d vs.(4.0 ± 0.1) d,t =24.9227,P =0.0000],defecation[(4.3 ± 0.6) d vs.(5.5 ± 1.1) d,t =7.9189,P =0.0000],extubation [(5.3±1.3)d vs.(10.1±2.2)d,t=15.5690,P=0.0000],hospitalization[(12.3±2.5)d vs.(18.6± 3.2)d,t=12.9864,P=0.0000],postoperative body weight[(57.2±4.9)kg vs(49.0±7.2)kg,t=-7.8408,P=0.0000],plasma protein[(133.2± 11.2)g/L vs(104.5± 10.3)g/L,t=-16.0055,P=0.0000],hemoglobin[(4.7 ± 1.0) g/L vs (3.2 ± 0.6) g/L,t =-11.0991,P =0.0000] and peripheral blood lymphocyte count[(3.5 ± 0.7) × 109/L vs (2.1 ± 0.4) × 109/L,t =-15.0088,P =0.0000].Conclusions Effects of postoperative gastrointestinal decompression in elderly patients with gastric cancer are similar between with routine gastric tube and with enteral feeding tube.However,the enteral feeding tube-induced enteral nutrition shows fewer side effects and complications,better nutritional and immune effects,and faster postoperative recovery,which is worthy of a generalization and application.