J.Jpn. Surg. Soc.. 126(3): 261-266, 2025

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Feature topic

ADJUVANT CHEMOTHERAPY FOR LOCALLY ADVANCED GASTRIC CANCER

There is no dispute that surgery is the mainstay of treatment for resectable, locally advanced gastric cancer. Several clinical trials have been conducted to demonstrate the superiority of extended surgery; however, the efficacy of prophylactic para-aortic lymph node dissection, splenectomy for upper-third advanced gastric cancer, and omentobursectomy was not confirmed. On the other hand, the efficacy of perioperative chemotherapy has been confirmed in clinical trials, and standard treatment for resectable, locally advanced gastric cancer has been D2 gastrectomy with postoperative adjuvant chemotherapy with S-1 since the ACTS-GC. In Europe, preoperative adjuvant chemotherapy was a focus, and the MAGIC trial demonstrated the superiority of pre- and postoperative chemotherapy with the ECF regimen. In Japan, treatment development is shifting from postoperative adjuvant chemotherapy to preoperative adjuvant chemotherapy, which has been shown to be effective in some locally advanced gastric cancer patients with expected poor survival outcomes, such as bulky N/aortic lymph node-positive cases. A phase Ⅲ trial (JCOG1509) is currently underway to evaluate the superiority of preoperative SOX therapy in stage Ⅲ patients. A phase Ⅲ trial (JCOG2203) is also underway to evaluate the superiority of preoperative three-drug combination chemotherapy (DOS or FLOT) in esophagogastric junction adenocarcinoma, and the results are awaited.

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