Exploration and thoughts on perioperative treatment of advanced gastric cancer

Perioperative treatment is critical to improve the outcomes of patients with advanced gastric cancer. There are three therapeutic modes of perioperative treatment for resectable gastric cancer: neoadjuvant chemotherapy+ D1/D2 surgery+ adjuvant chemotherapy, D0/D1 surgery+ adjuvant radiochemotherapy, and D2 surgery+ adjuvant chemotherapy. Over the decades, a large number of clinical studies had been conducted to optimize the perioperative treatment mode of gastric cancer, including the postoperative radiotherapy and chemotherapy, and perioperative chemotherapy, and to explore the feasibility of preoperative radiochemotherapy, targeted therapy, and immunotherapy in advanced gastric cancer. After nearly 20 years of development and exploration, although the perioperative treatment mode for advanced gastric cancer has become standardized, there are still some core issues that need to be solved urgently, including the selection of population for perioperative treatment, the limitation of efficaly evaluation criteria, insufficient emphasis on laparoscopic exploration before neoadjuvant treatment, and lack of exploration in esophagogastric junction cancer. We should fully integrate the current clinical research data into clinical practice, adopt a multidisciplinary diagnosis and treatment mode, and follow the principles of standardized diagnosis and treatment based on a multi-dimensional analysis of patient characteristics, and formulate the most reasonable treatment strategy to ultimately benefit patients.