Innovative perioperative strategies in advanced gastric cancer: assessing the surgical safety of neoadjuvant therapy

Gastric cancer remains one of the most common and challenging abdominal malignancies worldwide, with a significant proportion of cases diagnosed at advanced stages. Neoadjuvant therapy can be safely incorporated into radical gastrectomy pathways, supporting innovative, multidisciplinary treatment strategies for advanced gastric cancer.

Recent advances in perioperative oncology have introduced neoadjuvant therapy (NAT) as a key component of multidisciplinary treatment, with the aim of improving tumor control and surgical outcomes. The integration of systemic therapy before surgery has raised a number of discussions regarding its potential impact on postoperative recovery and surgical morbidity.

This study presents a retrospective analysis of a continuous cohort of patients with advanced gastric cancer who underwent radical gastrectomy between January 2016 and December 2025. Patients were divided into two groups according to the treatment strategy: neoadjuvant therapy followed by surgery (NAT) and initial surgery (US). We evaluated demographic and clinical characteristics, intraoperative parameters, postoperative complications, 30-day mortality, and pathological outcomes. The results obtained by the study demonstrate that neoadjuvant therapy does not increase the rate of postoperative complications after radical gastrectomy. These findings support the safe implementation of innovative perioperative treatment protocols that combine systemic therapy with radical surgery. By confirming the feasibility of this multidisciplinary approach, the study contributes to the continued development of evidence-based, patient-centered strategies for the management of advanced gastric cancer. Quality of life and personalized treatment selection are considered to maximize the benefits of these emerging therapeutic innovations.