Gastric Cancer最新文献

{"title":"Pronounced ethnic and sex disparities in gastric cancer burden and healthcare utilization in Inner Mongolia: a 9-year population-based cohort study.","authors":"Yuehan Duan, LiYing Qiao, Yunfeng Xi, Buqi Na, Weiwei Kang, Guozhen Liu, Yutong Wang, Sheng-Feng Wang","doi":"10.1007/s10120-026-01740-z","DOIUrl":"10.1007/s10120-026-01740-z","url":null,"abstract":"","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":" ","pages":"702-714"},"PeriodicalIF":6.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147722663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The density of tumour infiltrating lymphocytes in oesophago-gastric cancer varies with disease stage, geographical region and treatment: a post hoc analysis of nine phase III clinical trials.","authors":"Georgina A Keogh, Nina Šefčovičová, Tomio Arai, Myeong-Cherl Kook, Jon P Laye, William H Allum, Sameira Arif, Avani Athauda, Hee Kyung Chang, Jae-Ho Cheong, Mee-Yon Cho, David Cunningham, Lara Heij, Andrew F Irvine, Hee Sung Kim, Hyunki Kim, Young-Woo Kim, Ruth E Langley, Sung Hak Lee, Katharina von Loga, Matthew G Nankivell, Takashi Oshima, Russell D Petty, Xiuxiang Tan, Shiro Tanaka, Akira Tsuburaya, Judith de Vos-Geelen, Nicholas P West, Jake Emmerson, Jamie R Stokes, Derek R Magee, David A Cairns, Heike I Grabsch","doi":"10.1007/s10120-026-01739-6","DOIUrl":"10.1007/s10120-026-01739-6","url":null,"abstract":"<p><strong>Background: </strong>Tumour infiltrating lymphocytes (TILs) are a key component of the tumour microenvironment. To establish a clinically relevant TILs cut-off for patients with oesophago-gastric (OG) cancer, it is essential to know whether TILs density varies by patient and/or disease characteristics.</p><p><strong>Materials and methods: </strong>TILs were quantified as TILs/mm² (TILs density) by a deep-learning algorithm applied to digitised Haematoxylin/Eosin (H&E)-stained biopsies and resection specimens from 4628 patients from nine phase III trials. 4533 patients with TILs density and matched clinicopathological data were included in the final analyses. Associations between TILs density, disease stage, geographical region (UK versus Asia), sex, age, and treatment were analysed.</p><p><strong>Results: </strong>Median TILs density was higher in pre-treatment biopsies from patients with early-stage versus late-stage disease (962 vs 479 TILs/mm², p < 0.001). Within the same geographical region and disease stage, TILs density was similar across different chemotherapy regimens. In UK-led trials of early-stage disease, post-chemotherapy resections showed higher TILs density than chemotherapy-naïve resections (618 vs 571 TILs/mm², p = 0.003). TILs density was higher in Asian tumours compared to UK tumours (1419 vs 571 TILs/mm², p < 0.001). No significant associations were observed with age or sex.</p><p><strong>Conclusions: </strong>This is the largest study to date evaluating TILs density in OG cancer. TILs density varied with stage and geographical region but not by age or sex. These findings may explain enhanced response to immunotherapy observed in published studies of patients with early-stage disease and highlight the need to account for baseline TILs heterogeneity when interpreting TILs as a possible biomarker in future studies.</p>","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":" ","pages":"762-776"},"PeriodicalIF":6.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13314682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circulating tumor DNA-guided response evaluation in patients with previously treated gastroesophageal adenocarcinoma.","authors":"Cecilie Riis Iden, Nadia Øgaard, Salah Mohammad Mustafa, Ida Coordt Elle, Mette Yilmaz, Marianne Nordsmark, Tenna Henriksen, Torben Kruse, Mads Thomassen, Per Pfeiffer, Claus Lindbjerg Andersen, Lene Bæksgaard, Camilla Qvortrup, Morten Mau-Sørensen","doi":"10.1007/s10120-026-01743-w","DOIUrl":"10.1007/s10120-026-01743-w","url":null,"abstract":"<p><strong>Background: </strong>Systemic treatment offers only modest survival benefits in previously treated metastatic gastroesophageal adenocarcinoma (GEA). Treatment monitoring using imaging-based response assessments are often delayed and imprecise, highlighting the need for biomarkers to guide early treatment decisions. We evaluated the value of circulating tumor DNA (ctDNA) for prognosis, patient selection, and on-treatment monitoring in patients with previously treated GEA.</p><p><strong>Methods: </strong>This retrospective study aimed to investigate whether baseline ctDNA levels and early ctDNA changes assessed by ctDNA-RECIST were associated with survival outcomes in a randomized Phase 2 trial comparing trifluridine-tipiracil plus bevacizumab or trifluridine-tipiracil alone. Plasma samples were collected at baseline and during treatment (weeks 4 and 8). ctDNA was quantified by a tumor-agnostic methylation-specific digital droplet PCR (ddPCR) assay.</p><p><strong>Results: </strong>Plasma samples were available in 86 patients out of a total of 103 patients included in the trial. Patients with the highest baseline ctDNA levels (top 20%, n = 18) had significantly shorter progression-free survival (PFS; median 1.8 vs. 4.6 months; HR 2.2, p = 0.005) and overall survival (OS; median 5.5 vs. 9.9 months; HR 2.2, p = 0.004) compared to those with lower levels. Early progression by ctDNA at four weeks (HR 2.4, p = 0.003) and at eight weeks by radiological assessment (HR 2.9, p = 0.001) were both associated with inferior OS.</p><p><strong>Conclusions: </strong>ctDNA is a strong prognostic biomarker in refractory GEA. High baseline levels and early increases identify patients unlikely to benefit from treatment. Prospective validation is needed, but ctDNA monitoring may enable earlier therapeutic decision-making in clinical practice.</p>","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":" ","pages":"798-807"},"PeriodicalIF":6.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13315376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tackling similarities and differences in global practice guidelines for gastric cancer: a review on the latest Taiwan guidelines with Asia-Pacific, European and US guidelines.","authors":"Chih-Chieh Yen, I-Chen Wu, Cheng-Chan Yu, Ming-Huang Chen, Nai-Jung Chiang, Wen-Liang Fang, Kuo-Hsing Chen, Chieh-Chang Chen, Tzu-Chan Hong, Yen-Cheng Chen, Ming-Wun Wong, De-Chuan Chan, I-Shu Chen, Yen-Yang Chen, Yueh-Wei Liu, Jiann-Ming Wu, Wen-Chi Chou, Chan-Keng Yang, Jun-Te Hsu, Ta-Sen Yeh, Li-Yuan Bai, Yi-Fang Chang, Yao-Yu Hsieh, Cheng-Ming Peng, Jaw-Yuan Wang, Hui-Hua Hsiao, Li-Tzong Chen, Kun-Ming Rau, Chia-Jui Yen, Jen-Shi Chen, Yan-Shen Shan","doi":"10.1007/s10120-026-01753-8","DOIUrl":"10.1007/s10120-026-01753-8","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer (GC) remains a global health burden. While international guidelines share consensus, variations exist in disputed issues. The 2025 Taiwan Consensus and Management Guidelines for Gastric Cancer had just been released. We compared the key recommendations with established international guidelines.</p><p><strong>Methods: </strong>A multidisciplinary taskforce addressed key questions and recommendations using modified Delphi method and evidence-based approaches. The comparative review aimed to elucidate similarities and differences among guidelines from Taiwan, Japan, South Korea, China, Europe, and the US.</p><p><strong>Results: </strong>Guidelines converge on absolute endoscopic resection criteria for early GC but differ in extended indications and perioperative approaches for locally advanced disease. Heterogeneity exists in biomarker assessment protocols, cutoff thresholds, and companion diagnostics. For metastatic disease, consensus exists on anti-HER2, anti-VEGF, immunotherapy, and biomarker-driven strategies, though oligo-metastatic definitions and intraperitoneal chemotherapy indications remain controversial.</p><p><strong>Conclusion: </strong>Optimal GC management requires integrating global evidence with regional contexts. The comparative review addresses heterogeneity among international guidelines, which helps harmonize management strategies as therapeutic standards evolve.</p>","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":" ","pages":"681-701"},"PeriodicalIF":6.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13315491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma proteomic signatures improve risk stratification and personalized screening for gastric cancer.","authors":"Xue Li, Wen-Hao Shi, Juan Zhu, Ying Chen, Bin Liu, Nai-Ren Zheng, Le Wang, Li Yuan, Ying-Ying Mao, Xiang-Dong Cheng, Ling-Bin Du","doi":"10.1007/s10120-026-01749-4","DOIUrl":"10.1007/s10120-026-01749-4","url":null,"abstract":"<p><strong>Background: </strong>Accurate identification of individuals at high risk of gastric cancer (GC) remains a major challenge for effective screening. We aimed to identify plasma proteomic signatures and develop a risk prediction model for GC risk stratification.</p><p><strong>Methods: </strong>Plasma proteomic profiling was performed using liquid chromatography-tandem mass spectrometry in a case-control discovery set (100 GC cases and 94 controls). Candidate proteins were evaluated in 52,552 UK Biobank participants with a median follow-up of 13.63 years, during which 92 incident GC cases were identified. Risk models integrating clinical, genetic, and proteomic factors were developed using LASSO-penalized Cox regression with stability selection and internally validated using bootstrap resampling.</p><p><strong>Results: </strong>Among 2306 differentially expressed proteins in discovery, 25 were replicated in validation at nominal significance (P < 0.05) with consistent directions. Two proteins (CTSD and GGH) remained significant after false discovery rate correction. A primary proteomic model (clinical factors plus five proteins) improved discrimination versus clinical model (optimism-corrected C-index: 0.745 vs. 0.732, P = 0.046). Risk stratification revealed a clear GC risk gradient: hazard ratios were 6.08 (95% CI 2.15-17.20) for moderate-risk and 23.88 (95% CI 8.66-65.87) for high-risk groups. The risk score was also associated with GC risk as continuous variable (HR per standard deviation: 1.09, 95% CI 1.08-1.11). The 15-year cumulative incidence ranged from 0.02 to 0.56% across risk groups. Decision curve analysis indicated improved clinical utility.</p><p><strong>Conclusions: </strong>Plasma proteomic signatures may improve GC risk stratification beyond traditional clinical factors and could support more targeted screening strategies. Further validation is warranted.</p>","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":" ","pages":"725-736"},"PeriodicalIF":6.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13315260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147941177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic value of para-aortic lymph node dissection in gastric cancer with extensive lymph node metastasis: integrated analysis of three phase II trials (JCOG2212A).","authors":"Takeyuki Wada, Masayuki Yokoyama, Seiji Ito, Tadayoshi Hashimoto, Kota Kawabata, Kazuhisa Ehara, Takashi Nomura, Masaki Aizawa, Ryohei Kawabata, Daisuke Takahari, Mitsuru Sasako, Akira Tsuburaya, Takeshi Sano, Masanori Terashima, Narikazu Boku, Yukinori Kurokawa, Takaki Yoshikawa","doi":"10.1007/s10120-026-01752-9","DOIUrl":"10.1007/s10120-026-01752-9","url":null,"abstract":"","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":" ","pages":"865-873"},"PeriodicalIF":6.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147769701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A phase II trial of ramucirumab and docetaxel as second-line treatment for patients with advanced gastric cancer (HGCSG 1903).","authors":"Yasuyuki Kawamoto, Kentaro Sawada, Kazuaki Harada, Iori Motoo, Takayuki Ando, Susumu Sogabe, Yoshimitsu Kobayashi, Masayoshi Dazai, Michio Nakamura, Kazuteru Hatanaka, Atsushi Ishiguro, Atsushi Sato, Shintaro Nakano, Yoshiaki Shindo, Ayumu Hosokawa, Ken Ito, Ayumu Yoshikawa, Akira Ueda, Kayoko Iuchi, Isao Yokota, Satoshi Yuki, Yoshito Komatsu","doi":"10.1007/s10120-026-01751-w","DOIUrl":"10.1007/s10120-026-01751-w","url":null,"abstract":"<p><strong>Background: </strong>Ramucirumab has shown efficacy in combination with paclitaxel in the second-line treatment of advanced gastric cancer (AGC). The efficacy and safety regarding the combination therapy of ramucirumab and docetaxel have not been reported. This treatment could reduce the incidence of neuropathy and patients' hospital visits.</p><p><strong>Methods: </strong>This was a multicenter, single-arm phase II trial. Patients with AGC who were refractory or intolerant to primary treatment were eligible. Patients received ramucirumab at a dose of 8 mg/kg on day1 and 15, and docetaxel at a dose of 60 mg/m² on day1 of a 28-day cycle. The primary endpoint was overall response rate (ORR). The secondary endpoints were progression-free survival (PFS), overall survival (OS), relative dose intensity, and safety.</p><p><strong>Results: </strong>A final analysis of efficacy and safety was performed in 35 patients. ORR was 25.7% (90% confidence interval [CI] 14.1-40.6) and disease control rate was 74.3% (90%CI 59.4-85.9). Median PFS and OS were 3.1 months (95%CI 2.1-4.2) and 11.5 months (95%CI 9.2-13.9), respectively. Grade 3 or higher adverse events that occurred in more than 10% of patients were neutropenia, leucopenia, febrile neutropenia, hypertension, and anorexia. The study protocol was amended to allow primary granulocyte-colony stimulating factor (G-CSF) prophylaxis during study period. There was no one incident febrile neutropenia after the protocol amendment. Peripheral sensory neuropathy occurred in 65.7% of all grades, with no incidence of grade 3 or higher.</p><p><strong>Conclusions: </strong>The combination therapy of ramucirumab and docetaxel demonstrated some efficacy for AGC. Caution is required regarding the occurrence of febrile neutropenia. This treatment might be considered as an option for second-line treatment of patients with AGC.</p>","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":" ","pages":"808-815"},"PeriodicalIF":6.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13315423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraperitoneal paclitaxel plus intravenous fluorouracil, leucovorin, oxaliplatin (FOLFOX) and nivolumab for gastric cancer with peritoneal metastasis: results from the IPLUS Phase II study.","authors":"So Hyun Kang, Jin Won Kim, Eunju Lee, Mira Yoo, Dongjae Jeon, Woochan Park, Minsu Kang, Hyeon Jeong Oh, Sa-Hong Min, Young Suk Park, Tae-Han Kim, Yoon Jin Lee, Ji-Won Kim, Sang-Hoon Ahn, Yun-Suhk Suh, Keun-Wook Lee, Hye Seung Lee, Hyung-Ho Kim","doi":"10.1007/s10120-026-01741-y","DOIUrl":"10.1007/s10120-026-01741-y","url":null,"abstract":"","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":" ","pages":"788-797"},"PeriodicalIF":6.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13315462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147722714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacokinetic and tissue distribution advantages of intraperitoneal oxaliplatin over systemic delivery: a swine model comparison of PIPAC and HPIPAC.","authors":"Mira Yoo, Hyung-Ho Kim, Du-Yeong Hwang, Chanmi Bang, Duk Yeon Kim, Sangyoung Lee, Soo Kyung Bae, Yooseong Jeong, Ji Yeon Kim, Dong-Kyu Lee","doi":"10.1007/s10120-025-01704-9","DOIUrl":"10.1007/s10120-025-01704-9","url":null,"abstract":"<p><p>BACKGROUND: Peritoneal metastases are a common manifestation with a dismal prognosis in advanced gastric cancer. Systemic chemotherapy has limited efficacy in this setting due to poor drug penetration into the peritoneum. Intraperitoneal (IP) chemotherapy techniques such as Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) and its hyperthermic variant, Hyperthermic Pressurized Intraperitoneal Aerosol Chemotherapy (HPIPAC), have emerged as targeted delivery methods to enhance peritoneal drug exposure while reducing systemic toxicity. This study compares the pharmacokinetics, tissue distribution, and peritoneal penetration of oxaliplatin administered via intravenous (IV) injection versus intraperitoneal chemotherapy using aerosolized drug delivery techniques, including PIPAC and HPIPAC. METHODS: In a swine model (n = 19), oxaliplatin was administered via IV (n = 5), PIPAC (n = 7), or HPIPAC (n = 7). Plasma oxaliplatin levels were measured at 14 time points over 6 h using liquid chromatography–tandem mass spectrometry. Tissue concentrations and tissue-to-plasma ratios were determined for major organs. Drug penetration into the peritoneum was visualized via matrix-assisted laser desorption/ionization mass spectrometry imaging. RESULTS: IV delivery resulted in rapid systemic exposure but minimal peritoneal concentrations (66.5 ng/mg). PIPAC and HPIPAC significantly enhanced peritoneal tissue concentration (5310.0 ng/mg and 2313.8 ng/mg, respectively) with markedly lower systemic exposure. The depth of tissue penetration was greater with IP delivery, with HPIPAC reaching an average of 2.69 mm. CONCLUSIONS: Compared to systemic IV chemotherapy, intraperitoneal delivery using aerosolized oxaliplatin under pressurized capnopneumoperitoneum achieved superior peritoneal drug concentration, deeper tissue penetration, and reduced systemic exposure. These findings validate PIPAC and HPIPAC as feasible and potential modalities for treating peritoneal metastases in gastric cancer.</p>","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":" ","pages":"578-587"},"PeriodicalIF":6.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147390026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reflux and stenosis after minimally invasive proximal gastrectomy with double-flap technique: risk factors and impact of robotic surgery.","authors":"Qingjiang Hu, Masaru Hayami, Noriyuki Ishida, Motonari Ri, Rie Makuuchi, Tomoyuki Irino, Takeshi Sano, Souya Nunobe","doi":"10.1007/s10120-026-01733-y","DOIUrl":"10.1007/s10120-026-01733-y","url":null,"abstract":"<p><p>BACKGROUND: Proximal gastrectomy (PG) with double-flap technique (DFT) is increasingly performed in East Asia as a function-preserving alternative to total gastrectomy. However, reflux esophagitis and anastomotic stenosis remain major concerns, and risk factors after minimally invasive approaches, including robotic surgery, have not been well defined. METHODS: We retrospectively analyzed 399 patients who underwent laparoscopic or robotic PG-DFT for esophagogastric junction (EGJ) or gastric cancers (GC) between 2009 and 2023. The primary endpoint was reflux esophagitis assessed by endoscopy at 1 year, and the secondary endpoint was anastomotic stenosis requiring balloon dilatation. Logistic regression analyses were performed to identify risk factors. RESULTS: Reflux occurred in 24 patients (6.0%) and stenosis in 51 patients (12.8%). Independent risk factors were EGJ cancer or GC with esophageal invasion for reflux (odds ratio [OR] 3.21, 1.31–8.00) and a narrow esophageal diameter (< 18 mm) for stenosis (OR 11.97, 5.93–24.66). Moreover, robotic surgery was associated with a lower incidence of reflux compared with laparoscopic surgery in patients with EGJ cancer or GC with esophageal invasion. In patients with a narrow esophagus, shorter operative time was associated with a lower risk of stenosis. CONCLUSIONS: Minimally invasive PG-DFT carries distinct risks of reflux and stenosis depending on tumor and anatomical factors. Robotic surgery was associated with a lower incidence of reflux in high-risk patients, whereas technical proficiency and shorter operative time may be critical for preventing stenosis in patients with a narrow esophagus. These findings may support individualized strategies and selective use of robotics to optimize outcomes after PG.</p>","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":" ","pages":"658-668"},"PeriodicalIF":6.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147573683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}