TY - JOUR
T1 - Total versus subtotal gastrectomy following neoadjuvant flot chemotherapy for distal diffuse gastric adenocarcinoma
T2 - an international cohort study
AU - Sivakumar, Jonathan
AU - Wong, Darren J.
AU - Hall, Katheryn
AU - Lee, Margaret M.
AU - Duong, Cuong P.
AU - Watson, David I.
AU - Donohoe, Claire L.
AU - Bright, Tim
AU - Aly, Ahmad
AU - Chan, Kevin
AU - Chan, David
AU - Merrett, Neil
AU - Gananadha, Sivakumar
AU - Lam, Yick Ho
AU - Kanhere, Harsh
AU - Smithers, BMark
AU - Bozin, Michael
AU - Read, Matthew
AU - Mori, Krinal
AU - Johnson, Mary Ann
AU - Wong, Enoch
AU - Martin, Sarah A.
AU - Ooi, Geraldine
AU - Al-Habbal, Yahya
AU - Liew, Chon Hann
AU - Bohmer, Robert
AU - Daruwalla, Jurstine
AU - Ballal, Mo
AU - Ranjan, Rukshan
AU - MacCormick, Andrew D.
AU - Pattison, Sharon
AU - Evennett, Nicholas
AU - Robertson, Jason
AU - Tan, James
AU - Gordon, Alexandra
AU - Bann, Simon
AU - Samarasam, Inian
AU - Gurunathan, Ramesh
AU - So, Jimmy
AU - Yeung, Jonathan
AU - Ferri, Lorenzo
AU - Griffiths, Ewen A.
AU - Phillips, Alexander W.
AU - Markar, Sheraz R.
AU - Chan, David
AU - Murphy, Thomas
AU - Reynolds, John
AU - Nilsson, Magnus
AU - Piessen, Guillaume
AU - van Hillegersberg, Richard
N1 - Publisher Copyright:
© The Author(s) 2026.
PY - 2026/7
Y1 - 2026/7
N2 - Objective: To compare perioperative, oncological, and survival outcomes of total gastrectomy (TG) versus subtotal gastrectomy (SG) in patients with locally advanced distal diffuse gastric adenocarcinoma treated with perioperative 5-fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) chemotherapy. Background: Diffuse distal gastric cancer is characterized by infiltrative growth patterns and early nodal metastasis. Whilst radical resection remains the cornerstone of curative treatment, the optimal extent of surgery with TG or SG, remains debated. Methods: This international multicenter cohort study analyzed data from patients with histologically confirmed diffuse gastric adenocarcinoma, located > 5 cm from the gastroesophageal junction. Endpoints included surgical margin status, nodal yield, perioperative morbidity, recurrence patterns, time-to-recurrence (TTR), and overall survival (OS). Outcomes were compared using multivariate analyses. Results: In total, 188 (39.0%) patients underwent TG and 294 (61.0%) underwent SG. After multivariable adjustment, surgical margin positivity was comparable between groups (OR 1.28, 95%CI 0.70–2.34). TG was associated with higher total nodal yield [Median(IQR) 31 (23–41) vs 28 (18–36), p < 0.001] but not metastatic nodal yield [Median(IQR) 1 (0–8) vs 1 (0–6), p = 0.065]. TG had longer operative time [Mean(SD) 318.5 (93.6) vs 301.0 (105.2) minutes, p = 0.040], extended hospital stay [Median(IQR) 8.5 (7.0–11.0) vs 7.0 (6.0–9.0), p < 0.001], and more complications (OR 1.55, 95%CI 1.05–2.30). Recurrence patterns and adjusted TTR (HR 1.29, 95%CI 0.95–1.75) were similar between groups. Adjusted OS was superior in the SG group (HR 1.69, 95%CI 1.20–2.38). Conclusions: In appropriately selected patients, SG has comparable oncological efficacy to TG with lower surgical morbidity for distal diffuse gastric adenocarcinoma post FLOT chemotherapy.
AB - Objective: To compare perioperative, oncological, and survival outcomes of total gastrectomy (TG) versus subtotal gastrectomy (SG) in patients with locally advanced distal diffuse gastric adenocarcinoma treated with perioperative 5-fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) chemotherapy. Background: Diffuse distal gastric cancer is characterized by infiltrative growth patterns and early nodal metastasis. Whilst radical resection remains the cornerstone of curative treatment, the optimal extent of surgery with TG or SG, remains debated. Methods: This international multicenter cohort study analyzed data from patients with histologically confirmed diffuse gastric adenocarcinoma, located > 5 cm from the gastroesophageal junction. Endpoints included surgical margin status, nodal yield, perioperative morbidity, recurrence patterns, time-to-recurrence (TTR), and overall survival (OS). Outcomes were compared using multivariate analyses. Results: In total, 188 (39.0%) patients underwent TG and 294 (61.0%) underwent SG. After multivariable adjustment, surgical margin positivity was comparable between groups (OR 1.28, 95%CI 0.70–2.34). TG was associated with higher total nodal yield [Median(IQR) 31 (23–41) vs 28 (18–36), p < 0.001] but not metastatic nodal yield [Median(IQR) 1 (0–8) vs 1 (0–6), p = 0.065]. TG had longer operative time [Mean(SD) 318.5 (93.6) vs 301.0 (105.2) minutes, p = 0.040], extended hospital stay [Median(IQR) 8.5 (7.0–11.0) vs 7.0 (6.0–9.0), p < 0.001], and more complications (OR 1.55, 95%CI 1.05–2.30). Recurrence patterns and adjusted TTR (HR 1.29, 95%CI 0.95–1.75) were similar between groups. Adjusted OS was superior in the SG group (HR 1.69, 95%CI 1.20–2.38). Conclusions: In appropriately selected patients, SG has comparable oncological efficacy to TG with lower surgical morbidity for distal diffuse gastric adenocarcinoma post FLOT chemotherapy.
KW - Diffuse gastric cancer
KW - Gastrectomy
UR - https://www.scopus.com/pages/publications/105038665973
U2 - 10.1007/s10120-026-01746-7
DO - 10.1007/s10120-026-01746-7
M3 - Article
C2 - 42043496
AN - SCOPUS:105038665973
SN - 1436-3291
VL - 29
SP - 827
EP - 840
JO - Gastric Cancer
JF - Gastric Cancer
IS - 4
ER -