Reply to “Is it possible that advanced-stage gastric cancer patients can be cured by surgery alone?”

Sep 29, 2026

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Letter to the editor responding to comments on an article about whether advanced-stage gastric cancer patients can be cured by surgery alone. The authors clarify lymph node metastasis classification (N1–N2 as regional, N3 as distant) and discuss the limited benefit of N3 lymph node dissection. They agree that pT3-4 disease and lymphadenopathy indicate higher recurrence risk, supporting adjuvant therapy, including S-1 after curative surgery, and consider targeted therapy and immunotherapy for recurrence or stage IV failures.

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Reply to “Is it possible that advanced-stage gastric cancer patients can be cured by surgery alone?”

Lymph node metastasis classification and surgical benefit

Adjuvant chemotherapy and treatment considerations (S-1, targeted therapy, immunotherapy)

J Chin MedAssoc LETTER TO THE EDITOR Reply to “Is it possible that advanced-stage gastric cancer patients can be cured by surgery alone?” Meng-Chao Chena,b, Hsuan-Yu Suc,d, Yen-Hao Sue,f,g,h, Kuo-Hung Huangc,d,i,*, Wen-Liang Fangc,d,i, Chii-Wann Lina, Ming-Huang Chend,j, Yee Chaod,j, Su-Shun Lod,k, Anna Fen-Yau Lid,l, Chew-Wun Wuc,d aDepartment of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, ROC; bDepartment of Neurosurgery, China Medical University Hospital, Taipei Branch, Taipei, Taiwan, ROC; cDivision of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; dSchool of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; eDepartment of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC; fDivision of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC; gDivision of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC; hTMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei, Taiwan, ROC; iGastric Cancer Medical Center, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; jCenter of Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; kNational Yang Ming Chiao Tung University Hospital, Yilan, Taiwan, ROC; lDepartment of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC DEAR EDITOR, Thank you for your comments1 for our article.2 With regard to lymph node metastasis, gastric cancer with lymph node metastasis, which is limited to N1 or N2 (NCCN guideline), is classified as regional lymph node metastasis. It has been proved that gastric cancer with D2 lymph node dissection is a standard procedure for gastric cancer surgery.3 These regional lymph nodes could be completely resected by lymph node dissection. If the lymph nodes metastasize to N3 region, it could be classified as distant lymph node metastasis. Lymph node dissection for N3 lymph nodes might have limited benefit for gastric cancer treatment. Unlike the GYN disease, we did not consider gastric cancer with regional lymph node metastasis as “systemic disease.” However, adjuvant chemotherapy for gastric cancer with lymph node metastasis after curative resection is beneficial for these patients. We agreed that GC patients with pT3-4 and/orthe presence of lymphadenopathy was at a higher risk of recurrence and should be applied with adjuvant treatment as NCCN guideline’s recommendation. With regard to postoperative adjuvant chemotherapy, there was less effective chemotherapy for gastric cancer after curative resection with D2 lymph node * Address Correspondence. Dr. Kuo-Hung Huang, Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail address: khhuang@vghtpe.gov.tw](ROC. E-mail address: khhuang@vghtpe.gov.tw) (K.-H. Huang). Author contributions: Dr Meng-Chao Chen and Dr Hsuan-Yu Su contributed equally to the article. Conflicts of interest: Dr Yee Chao, an editorial board member at Journal of the Chinese Medical Association, had no role in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2023) 86: 350. Received December 26, 2022; accepted December 30, 2022. doi: 10. 1097/JCMA.0000000000000875. Copyright © 2023, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/)) dissection. Since 2008, S-1 has been used a

FAQs

How do the authors classify lymph node metastasis in gastric cancer?

They classify gastric cancer with lymph node metastasis limited to N1 or N2 as regional lymph node metastasis, while metastasis to the N3 region is classified as distant lymph node metastasis.

Why might lymph node dissection for N3 nodes have limited benefit?

The authors state that lymph node dissection for N3 lymph nodes might have limited benefit for gastric cancer treatment.

What adjuvant treatment do the authors discuss after curative surgery?

They discuss the benefit of adjuvant chemotherapy after curative resection, including S-1 use for stage II or III disease, and they also mention therapeutic considerations for targeted therapy and immunotherapy in recurrence or stage IV after chemotherapy failure.

Sep 29, 2026

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