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Lookup NU author(s): Professor Alexander PhillipsORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© The Author(s) 2026. Objective: To compare perioperative, oncological, and survival outcomes of total gastrectomy (TG) versus subtotal gastrectomy (SG) in patients with locally advanced distal diffuse gastric adenocarcinoma treated with perioperative 5-fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) chemotherapy. Background: Diffuse distal gastric cancer is characterized by infiltrative growth patterns and early nodal metastasis. Whilst radical resection remains the cornerstone of curative treatment, the optimal extent of surgery with TG or SG, remains debated. Methods: This international multicenter cohort study analyzed data from patients with histologically confirmed diffuse gastric adenocarcinoma, located > 5 cm from the gastroesophageal junction. Endpoints included surgical margin status, nodal yield, perioperative morbidity, recurrence patterns, time-to-recurrence (TTR), and overall survival (OS). Outcomes were compared using multivariate analyses. Results: In total, 188 (39.0%) patients underwent TG and 294 (61.0%) underwent SG. After multivariable adjustment, surgical margin positivity was comparable between groups (OR 1.28, 95%CI 0.70–2.34). TG was associated with higher total nodal yield [Median(IQR) 31 (23–41) vs 28 (18–36), p < 0.001] but not metastatic nodal yield [Median(IQR) 1 (0–8) vs 1 (0–6), p = 0.065]. TG had longer operative time [Mean(SD) 318.5 (93.6) vs 301.0 (105.2) minutes, p = 0.040], extended hospital stay [Median(IQR) 8.5 (7.0–11.0) vs 7.0 (6.0–9.0), p < 0.001], and more complications (OR 1.55, 95%CI 1.05–2.30). Recurrence patterns and adjusted TTR (HR 1.29, 95%CI 0.95–1.75) were similar between groups. Adjusted OS was superior in the SG group (HR 1.69, 95%CI 1.20–2.38). Conclusions: In appropriately selected patients, SG has comparable oncological efficacy to TG with lower surgical morbidity for distal diffuse gastric adenocarcinoma post FLOT chemotherapy.
Author(s): Sivakumar J, Wong DJ, Hall K, Lee MM, Duong CP, Watson DI, Donohoe CL, Bright T, Aly A, Chan K, Chan DL, Merrett N, Gananadha S, Lam YH, Kanhere H, Smithers B, Bozin M, Read M, Mori K, Johnson M-A, Wong E, Martin SA, Ooi G, Al-Habbal Y, Liew CH, Bohmer R, Daruwalla J, Ballal M, Ranjan R, MacCormick AD, Pattison S, Evennett N, Robertson J, Tan J, Gordon A, Bann S, Samarasam I, Gurunathan R, So J, Yeung J, Ferri L, Griffiths EA, Phillips AW, Markar SR, Chan D, Murphy T, Reynolds J, Nilsson M, Piessen G, Wijnhoven B, van Hillegersberg R, van Berge Henegouwen MI, Lombardi PM, Liu DS
Publication type: Article
Publication status: Published
Journal: Gastric Cancer
Year: 2026
Pages: Epub ahead of print
Online publication date: 27/04/2026
Acceptance date: 09/04/2026
Date deposited: 26/05/2026
ISSN (print): 1436-3291
ISSN (electronic): 1436-3305
Publisher: Springer Nature
URL: https://doi.org/10.1007/s10120-026-01746-7
DOI: 10.1007/s10120-026-01746-7
PubMed id: 42043496
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