Asia Pacific Gastroesophageal Cancer Congress (APGCC) 2024 consensus statement on stage 2 and 3 locally advanced gastric and Siewert 3 junctional adenocarcinoma

Masuda Y 1 , Fong KL 1 , Yeo D 2 , Yeo C 2 , Chue KM 3 , Araba SB 4 Show all authors , Lim CW 5 , Yeung B 3 , Lee J 6 , Lin J 6 , Chia C 7 , Ng M 5 , Ng K 5 , Samol J 8 , Chia D 4 , Teh JL 9 , Sundar R 10 , Yong WP 11 , Tan HL 12 , Muro K 13 , Lordick F 14 , Wainburg Z 15 , Tan BC 16 , Kim G 17 , Suda K 18 , Law S 19 , Sano T 20 , Gurunathan R 21 , Chiu P 22 , Woo E 23 , Duong C 24 , Yang HK 25 , Long VD 26 , Kim HH 27 , Mahendren HA 28 , Lee HJ 29 , Samarasam I 30 , Gotoda T 31 , Liew R 4 , Shabbir A 4 , Aung MO 2 , Terashima M 32 , Cheong E 33 , So J 34 , Tan J 1

Affiliations 

  • 1 Department of Upper Gastrointestinal & Bariatric Surgery, Division of Surgery, Singapore General Hospital, Singapore, Singapore
  • 2 Upper Gastrointestinal & Bariatric Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
  • 3 Upper Gastrointestinal & Bariatric Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
  • 4 Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital, Singapore, Singapore
  • 5 Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
  • 6 Upper Gastrointestinal & Bariatric Surgery Service, Department of General Surgery, Changi General Hospital, Singapore, Singapore
  • 7 Division of Surgery and Surgical Oncology, Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), National Cancer Centre Singapore and Singapore General Hospital, Singapore, Singapore
  • 8 Department of Medical Oncology, Tan Tock Seng Hospital, Singapore, Singapore
  • 9 Upper Gastrointestinal & Bariatric Surgery Service, Department of General Surgery, Ng Teng Fong Hospital, Singapore, Singapore
  • 10 Center for Gastrointestinal Cancers, Yale Cancer Center, New Haven, United States of America
  • 11 Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
  • 12 OncoCare Cancer Centre, Singapore, Singapore
  • 13 Department of Clinical Oncology and Outpatient Treatment Centre, Alchi Cancer Centre Hospital, Nagoya, Japan
  • 14 Department of Medical Oncology, University Cancer Centre, Leipzig, Germany
  • 15 Department of Medicine, University of California Los Angeles Medical Centre, Los Angeles, CA, USA
  • 16 Department of Upper Gastrointestinal Surgery, Clinic for Digestive Surgery, Singapore, Singapore
  • 17 Department of Upper Gastrointestinal Surgery, Crest Surgical Practice, Singapore, Singapore
  • 18 Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, Japan
  • 19 Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Hong Kong, China
  • 20 Gastroenterological Center, The Cancer Institute Hospital, Tokyo, Japan
  • 21 Department of Surgery, Sunway Medical Centre, Subang, Selangor, Malaysia
  • 22 Division of Upper GI and Metabolic Surgery, Department of Surgery, Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong S.A.R, China
  • 23 Department of Surgery, University of British Columbia, Vancouver, BC, Canada
  • 24 Department of Surgical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Vic., Australia
  • 25 National Cancer Center, Goyang, Korea
  • 26 Gastro-Intestinal Surgery Department, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
  • 27 Comprehensive Cancer Center, Seoul National University Bundang Hospital, Seongnam, South Korea
  • 28 Hospital Sultanah Aminah, Johor Bahru, Malaysia
  • 29 Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
  • 30 Upper Gastrointestinal Surgery Unit, Department of General Surgery Unit 3, Christian Medical College, Vellore, India
  • 31 Department of Gastroenterology, Cancer Institute Hospital of JFCR, Tokyo, Japan
  • 32 Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Monagakubo, Nagaizumi-Cho, Sunto-Gun, Nagaizumi, Shizuoka, Japan
  • 33 Department of Upper Gastrointestinal Surgery, PanAsia Surgery, Singapore, Singapore
  • 34 Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital, Singapore, Singapore. sursbyj@nus.edu.sg
J Gastroenterol, 2025 Sep;60(9):1079-1090.
PMID: 40514519 DOI: 10.1007/s00535-025-02266-4

Abstract

BACKGROUND: While the development in multimodal therapies has helped improve treatment outcomes for patients with locally advanced gastric adenocarcinoma (LAGC), there still exist disparities in opinion with an optimal treatment plan. This consensus hopes to provide clinicians with structured guidelines to aid in the decision-making for treatment options for LAGC.

METHODS: The consensus statement was initiated by establishing a taskforce in collaboration with the Asia Pacific Gastroesophageal Cancer Congress (APGCC) and a multidisciplinary expert panel was selected. Clinical questions on LAGC where perceived variance in practice or opinion may exist were formulated. Studies involving patients with Stage 2 or 3 gastric or Siewert 3 junctional cancers with treatment arms of perioperative chemotherapy, neoadjuvant chemotherapy, adjuvant chemotherapy, immunotherapy and surgery were included. A total of two rounds of voting were performed. Consensus was determined to be reached when a single answer or a combination of either "strongly agree/agree" or "strongly disagree/disagree" responses exceeded 75%.

RESULTS: A total of thirteen clinical questions were developed. They were identified through five main categories: Distal LAGC, Proximal LAGC, Deficient mismatch repair tumors, Chemotherapy and Immunotherapy, and Elderly/Unfit patients. After two rounds of voting by our multidisciplinary expert panel, eleven out of a total thirteen clinical questions had reached consensus. No consensus was reached for two clinical questions.

CONCLUSION: The APGCC consensus statement aims to guide clinicians in the treatment options for LAGC and Siewert 3 junctional cancer and has clarified some of the roles of perioperative chemotherapy and immunotherapy.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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