ASO Author Reflections: High-Quality Perioperative and Surgical Therapy: The Impact of Tumor Response in Survival

Excerpt

Advanced gastric cancer has a dismal long-term survival in many Western countries, and surgery still is the only potential curative treatment. Moreover, many clinical trials testing adjuvant therapy have shown improved outcomes,1 and much discussion has focused on the best timing, regimens, treatment costs, and staging workup. The jury still is out concerning adjuvant versus neoadjuvant therapy and the best staging system. In many centers, endoscopic ultrasound (EUS) still is the gold standard for the T staging, yet recent data have shown that a dedicated computed tomography (CT) scan is as reliable as an EUS in addition to staging at the same time as the complete tumor-node-metastasis (TNM) assessment. This single-imaging strategy has a lower cost. Indeed, in many developing regions, surgeons may rely only on this strategy to decide whether the patient needs upfront surgery or preoperative treatment. Pros and cons remain to be discussed, but few studies have addressed the effect size of neoadjuvant treatment response in a D2 surgery population. …