[Timing of surgery after neoadjuvant chemotherapy for advanced gastric cancer]

Several studies have demonstrated the benefit of perioperative chemotherapy in the treatment of advanced gastric cancers, especially the neoadjuvant chemotherapy (NAC). Many NAC trials in the United States, UK and Japan have proved that NAC can shrink the tumor and metastatic lymph nodes, downstage the T and N staging, achieve more curative (R0) resection for the unresectable cases, and even improve survival. Various neoadjuvant chemotherapy regimens have different effects on the body, therefore the timing selection of surgery, surgical programs and goals are different accordingly. Optimal surgery after neoadjuvant chemotherapy should be based on full comprehension of the pharmacology and pharmacokinetics. Strict surgical quality control is necessary.