When Chemotherapy Before Surgery is Recommended for Stomach Cancer

In certain cases of advanced gastric cancer, doctors may recommend neoadjuvant chemotherapy—administering chemotherapy before surgery—to improve treatment outcomes. This approach is typically considered for patients whose cancer has been diagnosed at a more advanced stage. Upon admission, diagnostic procedures such as endoscopy and CT scans are performed to assess the extent of the disease. If the tumor appears to have deeply invaded the stomach wall, spread to nearby organs, or caused significant lymph node enlargement, there may be a high likelihood of lymph node or distant metastasis.

Performing surgery in these situations without prior chemotherapy may result in incomplete tumor removal and a higher risk of recurrence. By using chemotherapy first, the tumor can potentially shrink and become more localized, making it easier to remove completely during surgery. This process, known as downstaging, increases the chances of a successful, curative operation and improves long-term survival rates.

Additionally, most patients with advanced gastric cancer will require adjuvant chemotherapy after surgery. However, when chemotherapy is given post-surgery, it can be difficult to determine how effective the drugs are against the specific tumor. In contrast, administering chemotherapy before surgery allows for an in vivo sensitivity test, helping doctors evaluate how well the tumor responds to the medication. This information can guide further treatment decisions and improve outcomes after surgery.