J.Jpn. Surg. Soc.. 127(2): 172-177, 2026

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Feature topic

SURGICAL TREATMENT IN THE ERA OF IMMUNE CHECKPOINT INHIBITORS: FOCUS ON GASTRIC CANCER

In Japan, the standardization of D2 lymph node dissection and the establishment of postoperative adjuvant chemotherapy with S-1 have promoted the integration of surgery and systemic therapy in gastric cancer treatment. Recently, the introduction of immune checkpoint inhibitors (ICIs), such as nivolumab and pembrolizumab, has improved the prognosis of unresectable cases. Among responders, conversion surgery has emerged as a novel therapeutic strategy. Furthermore, the MATTERHORN trial demonstrated the efficacy of perioperative treatment combining durvalumab, a new ICI, with FLOT chemotherapy. In the era of immunotherapy, several challenges remain, including the establishment of pathological assessment systems for the immune-related pathological response (irPR), perioperative management strategies that account for immune-related adverse events (irAEs), and the application of robot-assisted surgery to ensure procedural precision and safety. Multidisciplinary collaboration will be essential to develop safe, effective surgical approaches integrated with immunotherapy. Gastric cancer surgery is now evolving toward a new paradigm of treatment design that harmonizes surgical precision with immunological strategy.

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