This protocol addresses resectable gastric cancer at defined early and locally advanced clinical stages — all without evidence of distant spread. The specific staging presentation determines both the surgical approach and subsequent management.

Clinical Scenario

Three presentations are covered: cT1 gastric cancer with submucosal invasion and no distant metastasis; cT1 gastric cancer with intra-abdominal (regional) lymph node metastasis and no distant metastasis; or cT2–cT3 N0 gastric cancer with no distant metastasis. Surgical resection with D2 lymph node dissection is the established standard; D1+ dissection is an option for selected early gastric cancer (cT1N0) patients with comparable survival outcomes.

Post-Resection Management — Partial Overview

Adjuvant chemotherapy is recommended following resection in patients with pathological stage II or III disease. The specific regimen and its duration are determined by pathological stage and lymph node status confirmed at surgery — not all presentations require the same approach.

The complete regimen, agent selection, and stage-specific decision algorithm are available in the full protocol below.

References DOI: 10.5230/jgc.2025.25.e11

Surgical resection with D2 LN dissection is the standard treatment for gastric cancer.

D1+ dissection can be performed during surgery for EGC (cT1N0) patients in terms of survival outcomes.

Adjuvant chemotherapy (S-1 or capecitabine and oxaliplatin [CAPOX]) is recommended in patients with pathological stage II or III gastric cancer.

Therefore, S-1 for one year remains the standard adjuvant treatment for pathological stage II gastric cancer.

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Treatment of Stomach Cancer with Intra-Abdominal Lymph Node Involvement or Submucosal Invasion (No Distant Metastasis)