[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-354804-105":59,"doc-detail-354804-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","great-debate-should-surgery-be-omitted-in-the-management-of-gastroesophageal-junction-cancers","Great Debate: Should Surgery Be Omitted in the Management of Gastroesophageal Junction Cancers?","","Advances in perioperative chemotherapy and immunotherapy for gastric and gastroesophageal junction (GEJ) adenocarcinoma have improved outcomes, particularly for mismatch-repair deficient (dMMR/MSI-H) tumors. Established pathologic complete response (pCR) rates have prompted whether surgery can be safely omitted. The article presents a two-expert debate on omitting surgery, weighing procedure-related morbidity and mortality against response-based strategies and limitations of assessing clinical complete response.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/great-debate-should-surgery-be-omitted-in-the-management-of-gastroesophageal-junction-cancers/354804/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/great-debate-should-surgery-be-omitted-in-the-management-of-gastroesophageal-junction-cancers/354804.png","ImageObject",300,407,{"name":92,"@type":93},"moss~","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-22",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why has the question of omitting surgery arisen in gastric and GEJ adenocarcinoma?","Question",{"text":113,"@type":114},"Perioperative therapies have improved substantially, and for dMMR/MSI-H tumors established pCR rates have raised the possibility of avoiding surgery in selected patients with strong responses.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What are the main concerns about omitting surgery?",{"text":118,"@type":114},"Surgical procedures such as total, proximal, and esophagogastrectomy remain highly morbid and carry meaningful mortality risk, especially in older patients and low-volume centers, and there is limited long-term evidence supporting omission.",{"name":120,"@type":111,"acceptedAnswer":121},"When is surgery most strongly recommended according to the article?",{"text":122,"@type":114},"Surgery remains the standard-of-care for patients with MMR-intact tumors; patients with dMMR/MSI-H disease achieving clinical complete response to immunotherapy may be considered for omission through shared decision-making.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},354804,1790174586,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":46},962090895452,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","[https://doi.org/10.1245/s10434-026-20293-0](https://doi.org/10.1245/s10434-026-20293-0)  \nAnnals of Surgical Oncology (2026) 33:9249–9256  \nORIGINAL ARTICLE GASTROINTESTINAL ONCOLOGY  \nGreat Debate: Should Surgery Be Omitted in the Management of Gastroesophageal Junction Cancers?  \nMeredith A. Gunder, MD, MS1 · Brian D. Badgwell, MD2 · Kaitlyn J. Kelly, MD, MAS3  \nReceived: 6 July 2026 / Accepted: 11 July 2026 / Published online: 26 July 2026  \nThis is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2026  \nAbstract  \nBackground Perioperative therapies for gastric and gastroesophageal junction (GEJ) adenocarcinoma have improved significantly in recent years, especially for mismatch-repair deficient (dMMR/MSI-H) tumors. Pathologic complete response (pCR) rates are now established which has raised the question as to whether surgery can be omitted.  \nMethods This article summarizes the debate between two gastric cancer experts supporting each side of the argument on the possibility of omitting surgery.  \nResults Total, proximal, and esophagogastrectomy remain highly morbid procedures that still carry significant risk of mortality, particularly in older patients and at low-volume centers. Patients with dMMR/MSI-H gastric and GEJ adenocarcinoma have a pCR rate to neoadjuvant immunotherapy of 60% and those with mismatch repair intact (MMR-intact) tumors experience pCR to neoadjuvant chemo-immunotherapy with a rate of approximately 20% . The ability to assess for clinical complete response in gastric and GEJ adenocarcinoma has limitations, however, and there is a lack of long-term data to support omission of surgery.  \nConclusion pCR rates are established and durable in gastric and GEJ adenocarcinoma. Omission of surgery is a consideration in patients with dMMR/MSI-H tumors with cCR to immunotherapy. Surgery remains the standard-of-care for patients with MMR-intact tumors but patients should be counseled about the possibility of pCR in shared decision making.  \nKeywords Gastric cancer · Gastroesophageal junction cancer · Gastric adenocarcinoma · Immunotherapy · Pathologic complete response  \nBackground  \nWith advances in chemotherapy and immunotherapy, nonoperative management (NOM) and organ preservation are increasingly being incorporated into treatment algorithms for a variety of malignancies, such as rectal adenocarcinoma and esophageal squamous cell carcinoma. 1,2 Although  \nBrian D. Badgwell and Kaitlyn J. Kelly have contributed equally to this work.  \n* Kaitlyn J. Kelly, MD, MAS[Kjkelly3@wisc.edu](Kjkelly3@wisc.edu)  \n1 Department of Surgery, Inova Schar Cancer Center, Fairfax, VA  \n2 Department of Surgery, MD Anderson Cancer Center, Houston, TX  \n3 Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI  \nsurgical resection with lymphadenectomy currently plays a critical step in curative-intent treatment for non-metastatic gastric cancer, there is a significant morbidity associated with gastric resection, particularly total gastrectomy.  \nIn terms of perioperative therapies relevant to microsatellite stable (MSS) gastric adenocarcinoma, we have had significant progress over the past 20 years. In 2006, the MAGIC trial regimen of cisplatin, epirubicin, and 5-fluorouracil was established as the standard-of-care perioperative therapy regimen, which yielded a pathologic complete response rate of approximately 5% and a 5-year overall survival of 36% .3 In 2019, the FLOT4 study was published, which compared the MAGIC regimen to 5-fluorouracil, oxaliplatin, and docetaxel (FLOT) perioperatively. FLOT yielded a pCR rate of 16% and 5-year overall survival of 45%, establishing itas the new standard-of-care at that time.4 Finally in 2025, the Matterhorn trial, which evaluated the addition of durvalumab to FLOT, demonstrated a 19% pCR rate and 2-year overall survival of 70% .5 This study defined our current  \nstandard-of-care perioperative therapy regimen. ","cbCaidc48s9n0BEa","https://ap.wps.com/l/cbCaidc48s9n0BEa","pdf",890597,"English","# Abstract\n## Background\n## Methods\n## Results\n## Conclusion\n# Background\n## Rationale for Nonoperative Management\n# PRO\n## Introduction","[{\"question\":\"Why has the question of omitting surgery arisen in gastric and GEJ adenocarcinoma?\",\"answer\":\"Perioperative therapies have improved substantially, and for dMMR/MSI-H tumors established pCR rates have raised the possibility of avoiding surgery in selected patients with strong responses.\"},{\"question\":\"What are the main concerns about omitting surgery?\",\"answer\":\"Surgical procedures such as total, proximal, and esophagogastrectomy remain highly morbid and carry meaningful mortality risk, especially in older patients and low-volume centers, and there is limited long-term evidence supporting omission.\"},{\"question\":\"When is surgery most strongly recommended according to the article?\",\"answer\":\"Surgery remains the standard-of-care for patients with MMR-intact tumors; patients with dMMR/MSI-H disease achieving clinical complete response to immunotherapy may be considered for omission through shared decision-making.\"}]","Great Debate: Should Surgery Be Omitted in the Management of Gastroesophageal Junction Cancers? | PDF",1790114112]