The impact of neoadjuvant therapy on precise dissection and quality control in gastric cancer surgery
LI Zi-yu
XING Ji-yao
Abstract：Although neoadjuvant therapy significantly im-proves tumor control rates and pathological complete response(pCR)rates,the tissue edema and fibrosis it induces obscure the anatomical planes of the gastric mesentery,thereby increas-ing surgical complexity and complication risks(e.g.,increased intraoperative blood loss and prolonged operation time).The tissue alterations primarily manifest as:(1)Edema causing dif-ficulties in identifying anatomical planes,obvious exudation in the surgical area,and tissues being prone to tearing.(2)Fibro-sis leading to the disappearance of anatomical spaces,making dissection difficult and increasing the risk of collateral dam-age.To address these challenges,the following surgical quality control strategies are recommended:(1)Precise clinical stag-ing to avoid overtreatment.(2)Prudent implementation of func-tion-preserving surgery.Standard gastrectomy with D2 lymph-adenectomy should still be adhered to currently.Exploration of reduced or omitted surgery should only be considered for spe-cific patient groups.(3)Prioritize dissection of normal tissue ar-eas,avoid entering incorrect anatomical planes,employ suc-tion devices for assistance,and enhance team collaboration.Future efforts should focus on establishing an intraoperative tissue alteration evaluation system,advancing multimodal pre-cision staging,exploring pathways for function-preserving sur-gery in clinical research,and optimizing perioperative treat-ment through multidisciplinary collaboration.
Keywords：gastric cancerneoadjuvant therapytissue alterationsurgical quality control
Publication Date：2025-07-01
Online Publishing Date：2025-09-04(First online date of this platform, not the publication date of the document)
Pages：6( 753-758 )