Early gastric cancer: Report of 58 cases

Background. This retrospective study was carried out to review our surgical experience and to define the clinicopathologic profile of early gastric cancer in a Western country with one of the highest incidences in the world. Methods. Fifty-eight patients who had gastric surgery for early gastric cancer were included in this study. Results. The incidence of early gastric cancer was 13.9% of the patients with resected gastric cancer (58/416). The mean age of these 58 patients at diagnosis was 56.8 ± 12.3 years (range, 30–81 years) and the male: female ratio was 2.4 : 1. The most common presenting symptom was epigastric pain (52.4%). All patients were treated by surgical resection. Tumors were typically located in the antrum (72.4%), with a predominance of lesser curvature lesions (89.7%). Macroscopically, the majority of the lesions (63.8%) were excavated (types IIc and III). Thirty tumors were intramucosal and 28 extended into the submucosa. Thirty were of the intestinal type and 28 of the diffuse type. The rate of regional lymph node metastasis was 10.4%. The overall 5-year survival rate was 93.9%. Conclusions. The excellent response to surgical resection of early gastric cancer reported by Japanese authors is reproducible in Western countries even in the presence of regional lymph node metastasis. For this reason an aggressive surgical approach should be taken for all early gastric cancer. Received for publication on Jan. 20, 1998; accepted on Apr. 30, 1998     

Surgical treatment of early gastric carcinoma

From January 1965 until December 1982, early gastric carcinoma cases comprised 765 of 2,235 curative resections and 17 of 620 noncurative resections, for a total of 782 cases. The rate of lymph node metastasis for mucosal carcinoma was 1.2%, and that for submucosal carcinoma was 18.2%. Gastrectomy with removal of the second-group lymph node proved adequate for submucosal carcinoma. The five-year survival rates for mucosal carcinoma and for submucosal carcinoma were 94.9% and 93.6% respectively. The rate of recurrence of mucosal carcinoma was 0.6%, against 2.5% for submucosal carcinoma. Adjuvant chemotherapy is necessary to obtain improved surgical results for submucosal carcinoma. Important factors affecting the recurrence of submucosal carcinoma are lymph node metastasis, macroscopic findings and histological findings. Ten out of 17 cases of noncurative resection had cancer cells at the resection margin, caused by inadequate resection.     

Surgical treatment of early gastric cancer

Our investigation comprises 778 cases of resection for early gastric cancer (27.4% of all stomach resections). The rate of lymph node metastasis was 1.2% in m (mucosal cancer) group, 3.3% in sm (submucosal cancer) 1 group and 22.6% in sm 2 group. In sm 2 group, lymph node extirpation of R2 is essential. The five year survival rates were 94.1% in the m group, 94.1% in the sm 1 group and 94.1 in the sm 2 group, respectively. The rate of recurrence of m group was 0.6%, against 3.3% for sm 2 group. Sm 2 with well-differentiated, n(+) and Borrmann types are high risk groups. Adjuvant chemotherapy is necessary to obtain improved surgical results for the high risk groups. Cases of early gastric cancer exist which are beyond help by surgical means.     

Pathology of early invasive adenocarcinoma of the esophagus or esophagogastric junction: implications for therapeutic decision making

BACKGROUND: As an alternative to surgical resection, endoscopic treatment modalities are being explored for the treatment of patients with early esophageal carcinoma. This study aimed to evaluate patterns of local growth and regional dissemination of early adenocarcinoma of the esophagus or esophagogastric junction, as these pathologic features may contribute to rational therapeutic decision making. METHODS: Among 173 patients who underwent esophageal resection for invasive adenocarcinoma (1993-1998), 32 (19%) had early stage cancer (pT1). Clinical records, pathology reports, and original slides of the surgically resected esophagus were reviewed in each case. RESULTS: In 12 patients tumor invasion was limited to the mucosa, whereas in 20 patients the tumor showed infiltration of the submucosa. All cancers were associated with intestinal metaplasia. Areas of high grade dysplasia accompanied 27 of the 32 cancers (84%). Intramucosal cancer had no lymph node metastasis but presented as multifocal disease in 42% of cases and extended under preexisting squamous mucosa in 17% of cases. In submucosal cancer, lymph node metastases were present in 30% of cases. Disease specific 3-year survival for patients with intramucosal cancer was 100% and for those with submucosal cancer 82% (P = not significant). CONCLUSIONS: Based on the local growth pattern of intramucosal adenocarcinoma of the esophagus or esophagogastric junction, endoscopic treatment of patients with this disease should be applied with caution. For submucosal carcinoma, surgery is the mainstay of treatment, as lymph node metastasis is frequently present. Both subclassifications of early cancer show a favorable outcome after esophagectomy.     

T_1期和T_2期胃癌的外科治疗(兼评早期胃癌的临床意义)

目的　通过分析Ｔ１ 期和Ｔ２ 期胃癌的疗效,评价外科治疗对早期胃癌的临床意义。方法　对１３２ 例接受根治性手术的Ｔ１ 、Ｔ２ 期胃癌患者的预后进行回顾性分析。结果　Ｔ１ 和Ｔ２ 期患者的肿瘤平均大小、术中淋巴结转移率、术后复发率以及术后生存率差异均有显著性,进一步分析发现,术中已有淋巴结转移的Ｔ１ 期患者的术后生存率,明显低于术中无淋巴结转移的同期患者;而术中无转移的Ｔ２ 期患者的术后生存率,与Ｔ１ 期患者的生存率相似。结论　Ｔ１ 期（ 早期）胃癌,如已有淋巴结转移,亦应施行Ｄ２ 手术;而属进展期的Ｔ２ Ｎ０ 期胃癌,由于手术治疗预后好,在考虑是否采用术后辅助治疗时可按早期胃癌对待     

早期胃癌的淋巴结转移规律及预后分析

目的 分析早期胃癌的临床病理特征与预后之间的关系及早期胃癌的淋巴结转移规律.方法 对1994年1月～2005年10月手术治疗并有完整资料的255例早期胃癌的临床病理学资料进行回顾性分析.结果 255例患者的总5年生存率为91.4%.单因素分析显示,肿瘤浸润深度、脉管瘤栓和区域淋巴结转移与患者术后生存率有关;而性别、年龄...     

Definition of the adaptation of endoscopic surgery for early gastric cancer. Special examination on the relationship between the histological differentiation of the intramucosal gastric cancer and the lymph node metastasis

Out of five hundred and nineteen surgically resected lesions which were histologically shown to be intramucosal gastric cancer, 247 were well differentiated, 98 were moderately differentiated, and 176 were poorly differentiated lesions. The incidence of lymph node metastasis in the 247 well differentiated, 98 moderately differentiated, and 176 poorly differentiated intramucosal adenocarcinomas were 0.8% (= 2/247), 2.1% (= 2/98), and 8% (14/176), respectively. The cumulative survival rate of 5 years after gastrectomy was 94.2% for the 247 well, 93.3% for the 98 moderately, and 93.7% for the 176 poorly differentiated adenocarcinomas. A pathological study on the atypism of the gland of the cancer and the condition of the proprial space under the cancer cells was conducted on 100 lesions of well differentiated adenocarcinomas in order to define the criteria of non-surgical endoscopic removal resection for early gastric cancer. Out of the 100 lesions mentioned above, there were only two well differentiated adenocarcinomas with lymph node metastasis in which the boundary between the epithelium of the cancer and the proprial space under the cancer was very unclear and the interstitial space in the propria under the cancer was very small. On the other hand, we have resected 73 intramucosal gastric cancers using the endoscopic surgical method called strip biopsy since 1984, and have followed up these cases. The cancers resected by strip biopsy, and were histologically intramucosal well differentiated adenocarcinomas shown to have a moderately maintained interstitial space under the cancer cells. And, up to the present, there has been no incidence of recurrence after strip biopsy for the 73 lesions mentioned above. According to these results, we have defined the criterion for early gastric cancer endoscopic surgery, as follows. Intramucosal cancer which is shown to be well differentiated adenocarcinoma with a moderately maintained interstitial space under the cancer cells is considered to be sufficient for non-surgical endoscopic resection.     

T1期和T2期胃癌的外科治疗（兼评早期胃的临床意义）

目的 通过分析Ｔ１期和Ｔ２期的胃癌的疗效，评价外科治疗对早期胃癌的临床意义。方法 对１３２例接受根治性手术的Ｔ１，Ｔ２期胃癌患者的预后进行回顾性分析。结果 Ｔ１和Ｔ２期患者的肿瘤平均大小，术中淋巴结转移率，术后复发率以及术后生存率差异均有显著性，进一步分析发现，术中有已有淋巴结转移的Ｔ１期患者的术后生存率，明显低于术中无淋巴结转移的同期患者，而术中无转移的Ｔ２期患者的术后生存率，与Ｔ１期患者的生存     

胃癌及区域淋巴结CD44v6、nm23-H1表达与其病理特征及预后关系的研究

目的:探讨胃癌及其区域淋巴结CD44V6、nm23-H1表达与胃癌病理特征及预后的关系.方法:本研究采用SP免疫组织化学方法对110例胃癌及613枚区域淋巴结组织中的CD44V6、nm23-H1的表达进行检测.结果:在胃癌原发灶和在淋巴结转移灶,CD44V6阳性表达率分别为65.5%和89.4%,nm23-H1阳性表达率分别为39.1%和16.8%.CD44V6、nm23-H1表达率与胃癌的组织学类型、浸润深度、淋巴结转移密切相关.胃癌原发灶CD44V6阳性表达组5年生存率显著低于阴性表达组(P＜0.01);nm23-H1阳性表达组5年生存率显著高于阴性表达组(P＜0.01).结论:对胃癌组织进行CD44V6、nm23-H1蛋白的检测,有助于预测胃癌进程和淋巴结转移的诊断,以及评估胃癌患者的预后.     

Outcome of prophylactic radical lymphadenectomy with gastrectomy in patients with early gastric carcinoma without lymph node metastasis

BACKGROUND: Prophylactic extended lymphadenectomy with gastrectomy may prolong survival in patients with early gastric carcinoma without lymph node metastasis. However, the therapeutic value of extensive lymphadenectomy in patients with early gastric carcinoma remains controversial. METHODS: The authors retrospectively analyzed 423 patients with early gastric carcinoma without lymph node metastasis who underwent gastrectomy and did not die of other diseases to evaluate the effect of prophylactic extended lymphadenectomy on postoperative survival. The postoperative survival rate of patients who underwent prophylactic extended lymphadenectomy was compared with that of patients who underwent prophylactic limited lymphadenectomy. RESULTS: Although extended lymphadenectomy did not appear to improve the postoperative survival rate of patients with mucosal tumors, it did improve the postoperative survival rate of patients with submucosal tumors. Whether prophylactic extended lymphadenectomy was performed significantly affected outcome in patients with early gastric carcinoma who had submucosal tumors without regional lymph node metastasis. CONCLUSIONS: Extensive lymphadenectomy with gastrectomy should be performed to prolong the survival of the patients with submucosal tumors.     

Pedunculated gastric tube interposition in an esophageal cancer patient with prepyloric adenocarcinoma

Gastric carcinoma is one of the malignancies that are most frequently associated with esophageal carcinoma.We describe herein our device for advanced esophageal cancer associated with early gastric cancer in the antrum.A 57-year-old man presenting with dysphagia and upper abdominal pain was admitted to our hospital.Preoperative examinations revealed locally advanced squamous cell carcinoma (SCC) of the middle thoracic esophagus (T3N0M0 Stage ⅡA) and mucosal signetring cell carcinoma of the gastric antrum (T1N0M0 Stage ⅠA).Although the gastric tumor appeared to be an intramucosal carcinoma,its margin was obscure,so endoscopic en-bloc resection was considered inadequate.We chose surgical resection of the gastric tumor as well as the esophageal SCC after neoadjuvant chemotherapy with 5-fluorouracil and cisplatin for advanced esophageal cancer.Following transthoracic esophagectomy with three-field lymph node dissection,the gastric carcinoma was removed by gastric antrectomy,which preserved the right gastroepiploic vessels,and a pedunculated short gastric tube was used as the esophageal substitute.Twenty-eight months after the surgery,the patient is well with no evidence of cancer recurrence.Because it minimizes surgical stress and organ sacrifice,gastric tube interposition is a potentially useful technique for esophageal cancer associated with localized early gastric cancer.     

Modified operation for an early stage gastric cancer

The standard operation for gastric cancer is carried out for advanced gastric cancer with serosal invasion accompanying patent disseminative metastasis to the peritoneum of the omental bursa and lymph node metastases. It consists of subtotal or total gastrectomy, omentobursectomy and extended lymph node dissection. An early stage cancer, which in Japan accounts for almost a half of the resectable cases of gastric cancer, shows no serosal invasion, and lymph node metastases are rare if the cancer remains intramucosal. Such cases represent about a half the cases of the early stage cancer. The diagnosis of the early stage cancer, especially if it remains intramucosal, is made by means of preoperative radiological and endoscopic examinations and intraoperative examination. Since 1977 we have been performing a modified operation as well for cases of the early stage cancer. The surgical procedure is as follows: reduction in the size of gastric resection by 2/3, pylorus-preserving gastrectomy and proximal gastric resection; preservation of the distal portion of the greater omentum and transverse incision of the upper abdomen instead of upper midline incision to prevent ileus due to intestinal adhesion to abdominal wound around umbilicus; sparing bursectomy; narrowing the area of lymph node dissection; sparing thoracotomy for cancer in the esophagogastric junction; sparing splenopancreatectomy; preservation of the hepatic branch of the vagal nerve and postoperative temporary oral administration of cholagogue to prevent postgastrectomy cholelithiasis. In addition, the primary lesion is isolated from the blood circulation by means of ligation of the drainage veins to diminish metastasis through the blood vessels (hepatic metastasis, etc.), which is the main cause recurrence after surgery for the early stage cancer. The results of this new surgery are satisfactory; the five-year postoperative survival rate is 100.0% and it reduced the time needed for surgery, anesthesia and blood transfusion.     

胃癌根治术后局部或区域性复发部位规律及复发后放疗疗效在确定术后放疗靶区中的意义

目的:探讨胃癌根治术后肿瘤局部或区域性复发的部位及其规律以及放疗的价值,同时建立新的胃癌根治术后淋巴结分组方法以指导放疗靶区的确定.方法:回顾性分析2006年3月-2010年2月共43例胃腺癌根治术后发生局部或区域性复发的患者,均经影像学检查证实为胃癌根治术后复发,其中10例残胃或吻合口复发患者经病理组织学活检予以确诊.对43例患者的局部或区域性复发部位规律进行分析.结果:43例患者中,吻合口或十二指肠残端复发11例(25.6％),肿瘤床复发5例(11.6％),残胃复发2例(4.6％),区域淋巴结转移35例(81.4％).中位术后复发时间为胃癌根治术后15个月.放疗后的中位生存时间为15个月,1年生存率为59％,2年生存率为31％.N分期越高,术后复发时间越短.中位肿瘤缓解时间为14个月,且与复发部位(P=0.023)和性别(P=0.038)有关.通过拟定新的胃癌根治术后淋巴结转移区域分区方法(包含Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ和Ⅵ区),指导放疗靶区的确定和勾画.结论:胃癌根治术后局部或区域性复发部位主要包括吻合口、十二指肠残端、肿瘤床、残胃和区域淋巴结,其中淋巴结转移是主要的肿瘤复发方式(主要发生在Ⅰ、Ⅲ和Ⅵ区).新的胃癌根治术后淋巴结转移区域分区方法能够指导放疗靶区的确定,在勾画放疗靶区时应包括上述区域.     

手术切缘对晚期声门型喉癌患者生存预后的影响

目的 探讨手术切缘对晚期声门型喉癌患者生存预后的影响.方法 选择接受手术治疗的140例晚期声门型喉癌患者,根据切缘情况分为阴性切缘与阳性切缘,比较二者局部复发率、区域性转移率;根据切缘范围分为≤3mm、4～5 mm、≥5 mm,比较三者局部复发情况;根据有无局部复发比较3年、5年生存率.结果 140例喉癌患者中28例患者的切缘为阳性,112例切缘阴性.阳性切缘患者中局部复发或淋巴结转移16例(57.14％),阴性切缘患者中局部复发或淋巴结转移19例(16.96％),差异具有统计学意义(P＜0.05).手术切缘≤3 mm的局部复发率为57.14％ (8/14),手术切缘4～5 mm的局部复发率为21.87％ (7/32),手术切缘≥5 mm的局部复发率为l0.64％(10/94),手术切缘≤3 mm的局部复发率显著高于手术切缘4～5 mm与≥≥5 mm的患者,比较差异具有统计学意义(P＜0.05).无局部复发患者3年、5年生存率分别为50.00％、36.61％,显著高于局部复发患者的17.86％、7.14％,比较差异具有统计学意义(P＜0.05).结论 手术切缘与晚期声门型喉癌患者的局部复发率及淋巴结转移率密切相关,切缘阳性患者复发率、转移率较高,预后较差,3年、5年生存率较低.术中可将切缘组织送快速冰冻病理检查,根据检查结果再实施手术,以降低切缘阳性率,减少复发,提高预后生存.     

早期胃癌的临床病理特征及预后分析

目的分析早期胃癌的临床病理特征与预后之间的关系。方法回顾性分析1994年1月至2005年10月间,在我院实施D2根治术且资料完整的255例早期胃癌患者的临床资料,采用Kaplan-Meier法进行生存分析,Logrank检验进行统计学比较,Cox比例风险模型进行多因素分析。结果 255例患者的5年生存率为91.4%。单因素分析显示,肿瘤浸润深度、脉管瘤栓和区域淋巴结转移与患者术后生存率有关;而性别、年龄、肿瘤大小、肿瘤位置、大体类型、分化程度与术后生存率无关。多因素分析显示,区域淋巴结转移是影响预后的独立危险因素。结论伴有区域淋巴结转移的早期胃癌患者预后较差,标准胃癌根治性手术后应接受综合治疗并严密随访。     

Current status and future perspectives in gastric cancer management

Gastric cancer is still a major health problem and a leading cause of cancer mortality despite a worldwide decline in incidence. Environmental and Helicobacter pylori (Hp) acting early in life in a multistep and multifactorial process may cause intestinal type carcinomas, whereas genetic abnormalities are related more to the diffuse type of disease. Primarily due to early detection of the disease, the results of treatment for gastric cancer have improved in Japan, Korea and several specialized Western centres. Surgery offers excellent long-term survival results for early gastric cancer (EGC). Advances in diagnostic and treatment technology have contributed to a trend towards minimal invasive surgery such as endoscopic mucosal resection (EMR) and laparoscopic surgery for selected mucosal cancers.In the Western world, however, more than 80% of patients at diagnosis have an advanced gastric cancer with a poor prognosis. The aim of surgery is complete removal of the tumour (UICC R0-resection), which is known to be the only proven, effective treatment modality and the most important treatment-related prognostic factor. Gastrectomy with preservation of the spleen and pancreas in most cases is the standard procedure. However, at present there is no consensus about the optimal extent of lymph-node dissection. The hypothesis that extended (D2) lymph-node dissection leads to improved survival has not been confirmed in randomized trials. Results from specialized centres and ongoing multi-institutional randomized trials, however, indicate that D2 dissection, with preservation of the spleen and pancreas, can be performed with the same safety as a D1 dissection. Furthermore, in 50% of patients with node-positive disease, the extraperigastric N2 nodes are involved (N2 disease) and thus an R0-resection is achievable only by a D2 node dissection resulting in a 5-year survival of about 30% for such patients. However, even after a D2 node dissection with curative potential, disease recurs in two-thirds of patients with locally advanced gastric cancer (LAGC) and is rapidly fatal. The need for an adjuvant treatment is obvious, but at present there is no such treatment of proven effectiveness. Promising results with preoperative chemotherapy, which increases the R0-resection rate, and intra-or early postoperative intraperitoneal chemohyperthermia to prevent peritoneal dissemination have been reported. However, randomized trials are necessary before these combined treatments become widely accepted. Present data indicate that the treatment of gastric cancer has become more and more sophisticated with a tailored therapy for individual cases. Treatment includes a broad spectrum of therapeutic options from EMR for selected mucosal cancers to aggressive combined treatment for LAGC. Precise knowledge of patterns of recurrence and metastases, critical evaluation of clinicopathologic variables, integration of high technology into diagnosis to predict accurately pre-treatment staging, and the surgeon's ability to perform minimally invasive surgery and D2 node dissection technique are necessary for an appropriate treatment option. All these prerequisites are best ensured by management in experienced surgical oncology units.     

Clinicopathological features and outcome of surgical treatment of 149 patients with early (pT1) gastric cancer

BACKGROUND: Controversy exists concerning the definition of, treatment approach to, prognostic factors of and survival data on early gastric cancer. PATIENTS AND METHODS: 149 patients who underwent curative gastrectomy for carcinoma between 1972 and 2002 and were classified as having early gastric cancer (T1Nany) were included into a retrospective study. Patients were followed for a median of 5.5 years. RESULTS: We observed an increase in the incidence of early gastric cancer from 7.7% in the 1970s to 22.2% in the 1990s. None of the patients with mucosal tumors had lymph node metastases while 18 (20%) submucosal tumors were node positive. Multivariate analysis of all patients identified depth of tumor infiltration as the only independent risk factor for lymph node metastases. The analysis has shown that none of the clinicopathological features are reliable predictors of nodal status in patients with submucosal invasion. Patients with early gastric cancer had a very good prognosis, 10-year disease-specific survival was 80% or more in all subgroups of patients except for node-positive tumors. Depth of the tumor invasion, lymph node status as well as sex were found to be independent prognostic factors for overall survival. CONCLUSIONS: Early gastric cancer has a very good prognosis after standard surgery. Our data support the use of conservative limited surgical procedures for appropriate patients with mucosal gastric cancer. Patients with submucosal lesions require the same treatment approach as those with more advanced gastric cancer unless clinical usefulness of sentinel lymph node biopsy will be established.     

The appreciation and limitation of regional gastrectomy for early gastric cancer

We performed limited surgical treatments, including modified radical gastrectomy (D1+ alpha) for 7 patients, segmental gastrectomy for 9 patients and regional gastrectomy for 13 patients from September 1999 to December 2004. Eligibility criteria were as follows: 1) mucosal gastric cancer without an ulcer and/or scar; 2) contraindication to EMR; 3) located at M or L area; 4) negative for lymph node metastasis in clinical and surgical findings. Regional gastrectomy, especially in the patients whose gastric cancer located at the side of greater curvature, improved postoperative remnant gastric function according to the average of half-emptying times determined by RI scintigraphy, endoscopic examination and so on. However, the accuracy of mucosal cancer without lymph node metastasis in clinical and surgical findings was 69% and there was a patient with recurrence of lymph node after regional gastrectomy. These limited surgical treatments were thought to be limited due to more careful diagnosis as to sentinel lymph node navigation surgery in the future.     

Prediction of recurrence after curative resection of gastric carcinoma invading the muscularis propria: a multivariate analysis

Background. In Japan, the incidence of gastric cancer invading the muscularis propria is about 10% of all patients with gastric cancer undergoing surgical resection. Although many prognostic factors for early gastric cancer and advanced gastric cancer have been identified, there are few reports concerning prognostic factors for gastric cancer invading the muscularis propria, and the characteristics of recurrence are not well understood. Methods. We retrospectively analyzed data on 167 patients with gastric cancer that had invaded the muscularis propria. All patients had undergone curative resection. Results. Recurrences were evident in 37 patients (22.2%). Based on our univariate analysis, the recurrence was associated with lymph node metastases. Multivariate analysis showed that independent risk factors for recurrence were lymph node metastases and location of tumor in the upper or lower one-third of the stomach. With respect to the pattern of recurrence, 17 (46.0%) were secondary to hematogenous recurrence, 8 (21.6%) to peritoneal dissemination, and 6 (16.2%) to a local recurrence in the remnant stomach and in regional lymph nodes. Most deaths occurred during the second year after surgery, and approximately two-thirds of all patients (64.8%) died within 3 years after surgery. Conclusion. In patients with the risk factors of lymph node metastases and tumor in the upper or lower one-third of the stomach, lymph node dissection and postoperative adjuvant therapy are vital to try to prevent recurrences, especially during the first 2 years after surgery. Received: November 1, 1999 / Accepted: March 23, 2000     

Response to neoadjuvant chemotherapy and effects of tumor regression in gastric cancer

AIMS: Aim of this study is the evaluation of the effects induced by neoadjuvant chemotherapy (NACT) and its impact on survival on a series of locally advanced gastric carcinomas. METHODS: Downstaging was assessed comparing pre-treatment clinical and laparoscopic staging with post-operative pathologic staging on 30 consecutive patients who completed a 3-year follow-up. Tumor downstaging and the grade of pathologic response were included in a statistical correlation between tumor regression induced by NACT and 3-year survival. RESULTS: In this series tumor downstaging was obtained in 13 out of 30 patients. After the completion of 3-year follow-up, overall survival was >37.5months with an overall survival rate of 56.7%; this figure reached up to 70.8% in those cases who benefited from a R0-resection (24/30 patients: R0-resection rate 80.0%). CONCLUSIONS: In this study the 3-year survival for locally advanced gastric cancer treated by NACT prior to "D2" surgical resection, compares favourably with historical series treated by surgery alone. Patients who obtained T-downstaging and subsequently benefited from a R0-resection had a definitely better chance of cure, according to a complete 3-year follow-up.