Surgery Completion Boosts Outcomes in Gastric/GEJ Adenocarcinoma

For patients with localized gastric or gastroesophageal junction (GEJ) adenocarcinoma, the path to a cure is a rigorous marathon. While the established standard of care involves neoadjuvant chemotherapy followed by surgical resection, a significant subset of patients never reaches the operating room.

New real-world data presented at the ESMO Gastrointestinal Cancers 2026 Congress underscores the critical importance of completing this curative-intent pathway. The retrospective study, which analyzed nearly 100 patients, revealed that while the majority of patients do proceed to surgery, those who fall off the treatment trajectory face significantly poorer survival outcomes.

Analyzing the neoadjuvant landscape

Researchers conducted a retrospective analysis of 96 patients with localized gastric or GEJ adenocarcinoma treated with neoadjuvant chemotherapy between 2018 and 2024. The cohort's median age was 69 years, and the majority were male (77.1%).

The clinical profile of the participants was representative of the typical oncology nursing workload: 79.2% of patients maintained an ECOG PS of 0–1, 72.9% presented with clinical stage III disease, while 27.1% were stage II. Gastric tumors were most prevalent (80.2%), followed by GEJ locations (19.8%).

In terms of treatment, 83.3% of the total cohort received the FLOT regimen (fluorouracil, leucovorin, oxaliplatin, and docetaxel), while 16.7% were treated with FOLFOX. Patients who ultimately proceeded to surgery were more likely to have received FLOT (88.0%) compared to those who did not (53.8%).

The "surgical gap": Why patients fail to proceed

The study found that 86.5% (n=83) of patients successfully underwent surgical resection. However, 13.5% (n=13) did not proceed to surgery, representing a critical gap in the curative pathway.

For oncology nurses, understanding the reasons behind this "surgical failure" is paramount for patient monitoring and advocacy. According to the data, the primary drivers for failing to reach surgery were:

• Disease progression: Accounted for 46.2% (6 patients) of the failures.
• Poor performance status/deterioration: Impacted 23.1% (3 patients).
• Patient refusal: Noted in 15.4% (2 patients).
• Comorbidities and other factors: Each accounted for 7.7% (1 patient each).

These findings suggest that nearly a quarter of surgical failures are due to physical deterioration, a factor that oncology nursing interventions — such as aggressive symptom management and nutritional support — aim to mitigate.

Clinical impact of surgical completion

The completion of the surgical phase was strongly correlated with superior clinical endpoints. Among the 83 patients who underwent surgery, researchers reported an R0 resection rate of 74.7%.

The survival benefits for the surgical group were marked:

• Progression-free survival (PFS): The median PFS was 14.6 months for the surgery group compared to 11.8 months for those who did not have surgery.
• Overall Survival (OS): Patients who underwent surgery achieved a median OS of 43.5 months, while those in the no-surgery group saw a median OS of 34.8 months.

The researchers noted that while the trend toward improved OS was clear, the limited sample size and follow-up duration might have influenced the statistical weight of the estimates. Nonetheless, the data reinforces the conclusion that failure to reach surgery is associated with poorer disease control.

Nursing implications: Maximizing the curative pathway

For the oncology nursing community, these results highlight the neoadjuvant phase as a high-stakes period. Nurses play a "gatekeeper" role in ensuring patients remain eligible for surgery by managing the high toxicity profiles of regimens like FLOT.T

he fact that 15.4% of patients refused surgery despite completing neoadjuvant therapy suggests a need for enhanced patient education and psychological support earlier in the treatment cycle. Furthermore, with 23.1% failing due to poor performance status, the role of the nurse in early identification of frailty and "pre-habilitation" becomes even more vital.

The study authors concluded that optimizing treatment strategies to maximize the completion of curative-intent pathways must remain a "key priority in clinical practice."

Reference

Laterza MM, Nicastro A, Izzo M, et al. Neoadjuvant chemotherapy and surgical completion in gastric and gastroesophageal junction adenocarcinoma. Poster presented at: ESMO Gastrointestinal Cancers Annual Congress; July 1-4, 2026; Munich, Germany.