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Invited Critique
April 2013

The Case for Neoadjuvant Therapy in Locally Advanced Gastric Cancer: Comment on “Multivisceral Resection for Locally Advanced Gastric Cancer”

Author Affiliations

Author Affiliation: Department of Surgery, Washington University School of Medicine, St Louis, Missouri.

JAMA Surg. 2013;148(4):361. doi:10.1001/2013.jamasurg.331

Pacelli et al1 reported the Italian experience with multivisceral resection for locally advanced gastric cancer, and they concluded that “en bloc multivisceral resection should be the therapeutic choice.” In truth, the case for a more selective approach, such as the response to chemotherapy, is better supported by their data. The expertise of the authors and contributing surgeons is not in question. The surgical results of this selected experience are commendable. However, a critical review demonstrates that the most important contribution to the outcomes was careful patient selection, and the conclusion encouraging surgery in an unselective manner is potentially a disservice to most patients with locally advanced gastric cancer.

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