Clinicopathological profile and survival impact of neoadjuvant chemotherapy in gastric and GE junction cancers undergoing D2 gastrectomy: Outcomes from a tertiary centre in North India
Sadaf Ali, Mohammed Younis Bhat, M. Riyaz Lattoo, Akashdeep Singh SohiObjectives:
Gastric cancer is the sixth most common malignancy and the third leading cause of cancer mortality worldwide. Although its incidence in India is comparatively low, the Kashmir Valley represents a high-risk region. The extent of lymphadenectomy in gastric cancer surgery remains debated between Eastern and Western practices. This study evaluates clinicopathological outcomes and survival after D2 gastrectomy and compares outcomes between patients receiving neoadjuvant chemotherapy and those undergoing upfront surgery to determine the impact of preoperative therapy on overall and disease-free survival in gastric and gastro-oesophageal junction adenocarcinoma in a tertiary centre in Kashmir.
Material and Methods:
A retrospective and prospective observational study was conducted at Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, from 2018 to 2022. Sixty patients with histologically proven gastric or GEJ carcinoma who underwent D2 gastrectomy were included. Clinical, pathological, and survival data were analysed using standard statistical methods.
Results:
The mean age was 57.9 ± 10.2 years with a male predominance (78.3%). The most common symptom was epigastric discomfort (38.3%), and the antropyloric region was the most frequent tumour site (51.7%). Subtotal gastrectomy was performed in 66.7% of patients. Median lymph node yield was 21, with ≥16 nodes retrieved in 81.6%. Postoperative morbidity occurred in 28.3% of patients, with no mortality. Most patients presented with stage III disease (51.7%); nodal involvement was observed in 65%. Lymph vascular invasion (88.3%) and perineural invasion (50%) were not significantly associated with survival. The 1-, 3-, and 4-year overall survival rates were 81%, 65%, and 52%, respectively. Patients receiving neoadjuvant chemotherapy (41.7%) demonstrated improved survival compared with upfront surgery (4-year OS: 55% vs. 48%).
Conclusion:
D2 gastrectomy is safe and effective when performed in experienced centres, achieving adequate lymph node dissection and acceptable morbidity. Neoadjuvant chemotherapy, particularly with the FLOT regimen, enhances survival outcomes and should be integrated into multimodal management for advanced gastric cancer.