Laparoscopy-assisted gastrectomy following neoadjuvant chemotherapy for advanced gastric cancer - strategies for development

The established treatment for advanced gastric cancer is open gastrectomy with D2 lymph node dissection and postoperative adjuvant chemotherapy with S-1 or capecitabine plus oxaliplatin. However, the prognosis of patients with stage III disease is not satisfactory. More intensive chemotherapy is required to improve survival. Considering the patient compliance observed with intensive doublet or triplet chemotherapy, the administration of neoadjuvant chemotherapy is an attractive and promising approach. Many phase III trials to evaluate neoadjuvant chemotherapy in eastern Asia are now ongoing. On the other hand, surgical approaches have shifted to laparoscopic surgery. Several phase III trials to evaluate the efficacy of laparoscopy-assisted distal gastrectomy (LADG) have been performed in Japan and Korea, in both patients with early and advanced disease. Therefore, the candidates for future standard treatment consist of multimodality treatments, including neoadjuvant chemotherapy and subsequent LADG, for patients with advanced tumors located in the middle to lower third of the stomach. The feasibility, safety and longterm survival of laparoscopic gastrectomy following neoadjuvant chemotherapy must be guaranteed when neoadjuvant chemotherapy is the standard of care. Based on this background, we conducted a randomized phase II trial to compare LADG and open distal gastrectomy (ODG) after neoadjuvant chemotherapy for gastric cancer.