OBJECTIVE:To evaluate morbidity and mortality after minimally invasive (MIG) versus open gastrectomy (OG) for gastric cancer (GC) in a large European population, with a subgroup analysis comparing total and subtotal gastrectomy. SUMMARY BACKGROUND DATA:Real-world European studies comparing postoperative outcomes between MIG and OG are lacking. METHODS:This retrospective study included GC patients undergoing curative-intent gastrectomy between 2017 and 2021 at 24 high-volume European centers participating in the GASTRODATA registry. The primary outcome was the perioperative complication rate after MIG versus OG. Propensity score matching (PSM) was performed to adjust for potential confounders. RESULTS:Of 2430 patients, 1,800 (74%) underwent OG and 630 (26%) MIG. MIG was performed in patients with smaller tumors, earlier stages, and less frequently receiving neoadjuvant treatment (P<0.001). MIG was associated with higher R0 resection rate (96.5% vs. 92.4% in OG), shorter hospital stay, lower perioperative complication rate (23.0% vs. 31.6%, P<0.001), and reduced 30-day and 90-day mortality rates (1.6% vs. 3.3%, [P=0.026] and 1.9% vs. 4.7%, [P=0.001], respectively). In sub-group analysis, MIG had fewer perioperative complications in subtotal (17.9% vs. 25.3%, P=0.005), but not total gastrectomy (31.5% vs. 36.1%, P=0.201). After PSM, MIG remaind significantly associated with lower perioperative complication rates compared to OG only in subtotal (OR=0.49, 95% CI, 0.30-0.80; P=0.005), but not in total gastrectomy (OR=1.15, 95% CI, 0.62-2.17; P=0.645). CONCLUSIONS:Minimally invasive subtotal gastrectomy was associated with fewer perioperative complications than OG, while this association was not observed for total gastrectomy. Minimally invasive subtotal gastrectomy should be considered a viable option in specialized European centers.

While Prognostic Nutritional Index (PNI) is an established predictor of outcomes in Asian gastric cancer (GC) patients, data among Western populations are limited. This study assessed the predictive value of PNI in European GC patients undergoing multimodal treatment. Data from GASTRODATA, the largest European repository of GC patients undergoing gastrectomy, were collected between 2017 and 2022. The primary outcome was textbook outcome (TO) achievement, and the secondary was 90‐day mortality. PNI was calculated one day before surgery, with a cut‐off of 45.5 based on ROC analysis. Among 721 patients included 60.7% were men. Most patients had advanced tumors (cT3‐4 = 75.2%) and metastatic lymph nodes (57.7%). Neoadjuvant chemotherapy (NAC) was administered to 46.7% of patients, and 32.9% received adjuvant chemotherapy. Median PNI was 49.5 (IQR 45.0–56.4). Low PNI was present among 30% of patients and was associated with decreased odds of TO achievement (OR = 0.57, 95% CI 0.37–0.89), higher 90‐day mortality (OR = 4.99, 95% CI 2.32–10.73). NAC administration was associated with lower morbidity risk (OR = 0.56, p = 0.0408), and low PNI was a predictor of receiving AC ( p = 0.0005). PNI was a valuable predictor for oncological outcomes and morbidity among European GC patients undergoing multimodal. While low PNI was associated with decreased odds of TO achievement and increased risk of 90‐day mortality, further prospective and nutritional intervention studies are warranted to standardize the PNI threshold and improve its clinical applicability.

Acute gastric volvulus (AGV), is an uncommon complication of large paraesophageal hernias (PEH), resulting in closed-loop obstruction that may lead to incarceration and strangulation. The aim of this study was to summarize the evidence on clinical characteristics, surgical treatment, postoperative complications (POC), recurrence, and 30-day mortality (30DM), in patients undergoing surgery for AGV secondary to PEH. A systematic review including studies on AGV secondary to PEH was conducted. Searches were performed in WoS, Embase, Medline, Scopus, BIREME-BV and SciELO. Primary outcomes included POC, 30DM and recurrence. Secondary outcomes comprised publication date, study origin and design, number of patients, volvulus type, hospital stay length, treatments; and methodological quality (MQ) of studies assessed using MInCir-T and MInCir-Pr2 scales. Descriptive statistics, weighted averages (WA), least squares logistic regression for comparisons, and meta-analysis of POC prevalence and HM were applied. Of 1049 studies 171 met selection criteria, encompassing 15,178 patients. The WA age of patients was 75.3 ± 13.9 years, with 51.3

In current guidelines, staging laparoscopy (SL) is recommended in patients with locally advanced gastric cancer (GC). This study aimed to assess the clinical practice of SL and its association with administration of systemic treatment in a European cohort of GC patients (GASTRODATA). In this retrospective cohort study, patients with locally advanced GC who underwent multimodal treatment in 24 European centers were analyzed. Patients with early (cT1) or metastatic GC at diagnosis and those with missing data on chemotherapy administration were excluded. Of 2558 patients, 1726 were selected, with 562 (32.6

To compare postoperative events and oncologic results between minimally invasive gastrectomy (MIG) and open gastrectomy (OG) in gastric cancer surgery. Evidence of the short-term and long-term results of MIG is still limited. A population-based cohort study included all patients undergoing elective gastric cancer resection with curative intent between 2014 and 2021 across 39 centers belonging to the EURECCA Spanish Registry. Postoperative complications, 90-day mortality, and 5-year overall survival (OS) and disease-free survival (DFS) were analyzed in the groups of MIG and OG using propensity score matching (1:1). Subtotal gastrectomy (SG) versus total gastrectomy (TG) was also assessed. A total of 1333 matched-pair patients were included. The use of MIG increased significantly from 2017. The comparison of OG and MIG showed similar results for overall complications (47.4% vs 44.7%), major complications (19.1 vs 18.2%), 90-day mortality (4.4% vs 3.2%), and failure to rescue (23.1% vs 17.3%), but the MIG group showed significantly shorter median length of hospitalization (P < 0.001) in the overall study population (8 vs 10 days) as well as in the subgroups of SG (7 vs 8 days) and TG (10 vs 11 days), and higher ≥ 15 nodes retrieval (84.2% vs 78.8%, P < 0.001). Anastomotic leakage after TG was high (about 17%) and did not differ between surgical approaches. Also, MIG and OG showed similar 5-year OS (62% vs 64.6%) and DFS (58.5% vs 56.5%). The implementation of MIG did not increase complications and showed similar oncologic outcomes as compared with OG.

Background/Objectives: Many patients with obesity require conversion bariatric surgery (CBS) after sleeve gastrectomy (SG). The objective of this study was to assess the evolution of LDL cholesterol and other cardiometabolic parameters in patients who have undergone an SG and require a CBS, as the metabolic effects of such conversion procedures remain insufficiently understood. Methods: A retrospective analysis was conducted in a non-randomized prospective cohort of patients with severe obesity who were previously treated with SG and undergoing CBS. Changes in LDL cholesterol levels after SG were compared to those following CBS using repeated-measures ANOVA. Results: Twenty-eight patients were included (mean age 44.5 ± 7.2 years; 68% female; mean BMI 47.3 ± 7.2 kg/m2). Of these, 57% underwent Roux-en-Y gastric bypass (RYGB), and 43% underwent single-anastomosis duodeno–ileal bypass with sleeve gastrectomy (SADI-S) as conversion procedures. The mean time between SG and CBS was 93.5 ± 45.3 months for RYGB and 31.0 ± 45.2 months for SADI-S. The change in LDL cholesterol pre- vs. post-SG was 3.3 mg/dL (95% CI: −13.6 to 20.1), whereas the change pre- vs. post-CBS was −25.7 mg/dL (95% CI: −37.5 to −13.9) (p < 0.001). Remission of high LDL-C was 18.8% after SG and 73.3% after CBS (p = 0.023). The cardiometabolic profile showed a marked improvement profile during the SG period, followed by maintenance of these improvements during the CBS period. Conclusions: CBS (with either RYGB or SADI-S) results in a reduction in LDL-C, in contrast to the initial surgery with SG. However, CBS does not appear to provide additional benefits over SG in terms of other cardiometabolic parameters.

Background: Malnutrition is common with esophagogastric cancers and is associated with negative outcomes. We aimed to evaluate if immunonutrition during neoadjuvant treatment improves patient's health-related quality of life (HRQOL) and reduces postoperative morbidity and toxicities during neoadjuvant treatment. Methods: A multicenter double-blind randomized controlled trial (RCT) was undertaken. Included patients had untreated nonmetastatic esophagogastric tumor, aged 18 >= years with a life expectancy of >3 months. The study was powered for 80% power to detect a clinically relevant difference in EORTC-QLQC30 with standard deviation of 15 between groups. Primary end point was the quality of life as measured by the global health status at 30 days after surgery. An intention-to-treat analysis was employed. Results: The study was terminated at the interim analysis stage. About 300 patients were randomized: 149 to the IMPACT group and 151 to the control-formula group. Patient groups were well-balanced in terms of age, sex, body mass index, WHO performance status, and clinical tumor stage. Analysis of the primary end point for the study of global health status at 30-day postoperatively failed to show any significant differences between the groups (55.4 +/- 18.6 [IMPACT] vs. 55.9 +/- 19.8 [control]; P = 0.345). No significant differences between the groups were detected in the majority of domains from EORTC QLQC30 and OG25 tools after neoadjuvant therapy and 30 days postoperatively. Finally, no significant differences were seen between groups in neoadjuvant therapy or postoperative complications, or tumor response. Conclusion: The results of this multicenter double-blind RCT fail to demonstrate any HRQOL benefits to the utilization of immunonutrition during neoadjuvant therapy in patients with esophagogastric cancer.

BACKGROUND:Main treatment options for pharyngoesophageal diverticulum are the surgical excision or diverticulopexy, always associated with a myotomy, and the endoscopic peroral myotomy. The aim of this study was to describe the outcomes of a consecutive surgical series. METHODS:Observational study of patients who underwent open surgery (2004-2024) and who had a 2-years structured follow-up. Main outcome were symptom resolution and postoperative complications. Baseline characteristics, surgical technique, reinterventions, readmission and recurrence were also analyzed. Descriptive statistics was used, including percentages, mean and standard deviations, and medians with complete ranges. RESULTS:During the study period, 40 patients (73% male) were operated on, with a mean age of 72 ± 11 years. Ninety-five percent presented dysphagia and/or regurgitation, while 2 patients were referred due to a history of pneumonia to bronchoaspiration. The most frequent surgical technique was cricopharyngeal myotomy combined with diverticulectomy. Postoperative morbidity was 15%, with no cases of esophageal fistula. There was no mortality, and the median hospital stay was 3 days. Initial symptom resolution was achieved in 95% of patients. During follow-up (median 7 years [1-20]), 2 recurrences were observed at 18 and 24 months, respectively, both successfully managed endoscopically. CONCLUSIONS:Surgical treatment achieves symptoms resolution in the vast majority of cases, with limited morbidity and recurrence.

To evaluate morbidity and mortality after minimally invasive (MIG) versus open gastrectomy (OG) for gastric cancer (GC) in a large European population, with a subgroup analysis comparing total and subtotal gastrectomy. Real-world European studies comparing postoperative outcomes between MIG and OG are lacking. This retrospective study included GC patients undergoing curative-intent gastrectomy between 2017 and 2021 at 24 high-volume European centers participating in the GASTRODATA registry. The primary outcome was the perioperative complication rate after MIG versus OG. Propensity score matching (PSM) was performed to adjust for potential confounders. Of 2430 patients, 1,800 (74%) underwent OG and 630 (26%) MIG. MIG was performed in patients with smaller tumors, earlier stages, and less frequently receiving neoadjuvant treatment (P<0.001). MIG was associated with higher R0 resection rate (96.5% vs. 92.4% in OG), shorter hospital stay, lower perioperative complication rate (23.0% vs. 31.6%, P<0.001), and reduced 30-day and 90-day mortality rates (1.6% vs. 3.3%, [P=0.026] and 1.9% vs. 4.7%, [P=0.001], respectively). In sub-group analysis, MIG had fewer perioperative complications in subtotal (17.9% vs. 25.3%, P=0.005), but not total gastrectomy (31.5% vs. 36.1%, P=0.201). After PSM, MIG remaind significantly associated with lower perioperative complication rates compared to OG only in subtotal (OR=0.49, 95% CI, 0.30-0.80; P=0.005), but not in total gastrectomy (OR=1.15, 95% CI, 0.62-2.17; P=0.645). Minimally invasive subtotal gastrectomy was associated with fewer perioperative complications than OG, while this association was not observed for total gastrectomy. Minimally invasive subtotal gastrectomy should be considered a viable option in specialized European centers.

OBJECTIVE:To compare postoperative events and oncologic results between minimally invasive gastrectomy (MIG) and open gastrectomy (OG) in gastric cancer surgery. BACKGROUND:Evidence of the short-term and long-term results of MIG is still limited. METHODS:A population-based cohort study included all patients undergoing elective gastric cancer resection with curative intent between 2014 and 2021 across 39 centers belonging to the EURECCA Spanish Registry. Postoperative complications, 90-day mortality, and 5-year overall survival (OS) and disease-free survival (DFS) were analyzed in the groups of MIG and OG using propensity score matching (1:1). Subtotal gastrectomy (SG) versus total gastrectomy (TG) was also assessed. RESULTS:A total of 1333 matched-pair patients were included. The use of MIG increased significantly from 2017. The comparison of OG and MIG showed similar results for overall complications (47.4% vs 44.7%), major complications (19.1 vs 18.2%), 90-day mortality (4.4% vs 3.2%), and failure to rescue (23.1% vs 17.3%), but the MIG group showed significantly shorter median length of hospitalization ( P < 0.001) in the overall study population (8 vs 10 days) as well as in the subgroups of SG (7 vs 8 days) and TG (10 vs 11 days), and higher ≥ 15 nodes retrieval (84.2% vs 78.8%, P < 0.001). Anastomotic leakage after TG was high (about 17%) and did not differ between surgical approaches. Also, MIG and OG showed similar 5-year OS (62% vs 64.6%) and DFS (58.5% vs 56.5%). CONCLUSIONS:The implementation of MIG did not increase complications and showed similar oncologic outcomes as compared with OG.

BACKGROUND:Surgical repair of large type III/IV paraesophageal hernia (PEH) is challenging especially in the presence of acute gastric volvulus (AGV). This study compared postoperative complications (POCs) and 30-day mortality between urgent and elective PEH repair. METHODS:Between 2007 and 2024, a matched case-control study was conducted in a tertiary care hospital in Barcelona, Spain. Patients undergoing PEH repair on an emergency basis or electively were matched (1:1) by age and sex (male/female). Cases were patients with AGV requiring urgent or semielective repair, whereas controls were patients with type III/IV scheduled for elective surgery. POC was the primary outcome variable. RESULTS:A total of 74 patients (37 cases and 37 controls) were analyzed. The mean age was 78.0 years (SD, 8.9). Cases and controls showed similar American Society of Anesthesiologists and modified frailty index scores, but the Charlson comorbidity index score was higher in the urgent group. Cases showed longer duration of surgery than controls (223 [68.4] vs 194 [45.9] minutes; P =.03), postoperative length of hospital stay (13.2 [13.8] vs 4.9 [4.1] days; P =.0008), and need of open or converted procedures (odds ratio [OR], 8.4; P =.008). Urgent surgery was an independent factor for POCs (OR, 7.4; P =.0001). Reoperation rates were unrelated to the type of surgery. Mortality was low (only elective cases), with comparable 90-day readmissions and recurrences between cases and controls. CONCLUSION:In this case-control study, urgent repair of complex PEH showed higher POC than elective surgery but 30-day mortality and readmission rates were similar.

Introduction: Palliative chemotherapy is the current standard among advanced gastric cancer (GC) patients with peritoneal metastasis (PM), while the role of gastrectomy with cytoreductive surgery and HIPEC remains unclear. The current study aimed to assess treatment outcomes among GC patients with PM undergoing gastrectomy and hyperthermic intraperitoneal chemotherapy (HIPEC) using multinational cancer registries. Methods: The analysis (2012-2022) included stage IV GC patients with PM undergoing gastrectomy and HIPEC from the European GASTRODATA Registry (EU cohort) and the American National Cancer Database (NCDB, U.S. cohort). The study outcomes were textbook oncological outcome (TOO) assessment and overall survival (OS). Results: Among 193 patients, 49.7 % were from the EU cohort and 50.3 % from the U.S. cohort. EU cohort had significantly higher rates of pT4 tumors (EU: 50 % vs U.S.: 40.2 %), metastatic lymph nodes (EU: 68.8 % vs U.S.: 54.6 %), and >16 lymph nodes evaluated (EU: 91.7 % vs U.S.: 68%). Postoperatively, the EU cohort had longer hospital stay (EU: 53.1 % vs 22.2 %, p < 0.001), with no significant differences in 30-day readmission (EU: 14.6% vs U.S: 7.2%, p = 0.11) and 90-day mortality (EU: 4.2 % vs U.S.: 9.3%, p = 0.25). TOO rates were 30.2 % and 32 % for EU and U.S. cohorts, respectively. Within the U.S. cohort, TOO achievement was associated with improved 1- (86.7% vs. 57.4 %), 3- (55.8 % vs. 29.7 %), and 5-year OS (50.2 % vs. 29.7%) (p = 0.0025) survival compared with non-TOO. Conclusions: Among patients with GC and PM undergoing gastrectomy and HIPEC, achievement of TOO was associated with decreased risk of postoperative complications (EU cohort) and improved long-term survival (U.S.

Objective: Positive peritoneal cytology is traditionally viewed as representative of metastatic disease and a poor prognostic factor. The objective of this multi-center study was to define the prognostic role of peritoneal cytology in curative gastrectomy, evaluate international variation in cytology sampling, and assess the impact on positive peritoneal cytology yields. Methods: This was a multi-center international retrospective cohort study of 16 tertiary gastric cancer centers. Adult patients who underwent peritoneal lavage cytology at staging laparoscopy and subsequent gastrectomy between 2009 and 2023 were included. The primary outcome measure was overall survival at five years. Multivariable Cox regression provided hazard ratios (HRs) with 95 % CIs, adjusted for relevant confounding factors. Results: 837 patients with no radiological or macroscopic M1 disease were included, with a mean age of 66 (IQR 58-73) and 71 % were male. Non-distal gastric cancer was most common (47 %), with 59 % and 43 % of tumors staged pT3/4 and pN2/3, respectively. 66 patients (7.9 %) had positive cytology. Positive cytology was not associated with overall survival in multivariable analysis, controlled for stage and neoadjuvant treatment (HR=1.0; 95 %CI 0.51-2.0). Higher T and N stages were associated with positive cytology (p < 0.001). The proportion of patients with positive cytology was variable, depending on how many quadrants were sampled. Conclusion: Positive peritoneal cytology with otherwise M0 disease was not associated with decreased survival after curative intent gastrectomy in this study, meaning prospective study is needed. The technique of performing peritoneal washings influenced cytology yield and thus must be standardized in a much-needed prospective evaluation of peritoneal cytology. Synopsis: The POPEC multicenter international retrospective cohort study included 837 patients receiving curative gastrectomy. This study showed the technique of performing peritoneal washings influenced cytology yield, however positive peritoneal cytology was not associated with decreased survival. Therefore, positive peritoneal cytology should not be considered an absolute contradiction to curatively intended gastrectomy.

Reasons for structural and outcome differences in esophageal cancer surgery in Western Europe remain unclear. This questionnaire study aimed to identify differences in the organization of esophageal cancer surgical care in Western Europe. A cross-sectional international questionnaire study was conducted among upper gastrointestinal (GI) surgeons from Western Europe. One surgeon per country was selected based on scientific output and active membership in the European Society for Diseases of the Esophagus or (inter)national upper GI committee. The questionnaire consisted of 51 structured questions on the structural organization of esophageal cancer surgery, surgical training, and clinical audit processes. Between October 2021 and October 2022, 16 surgeons from 16 European countries participated in this study. In 5 countries (31%), a volume threshold was present ranging from 10 to 26 annual esophagectomies, in 7 (44%) care was centralized in designated centers, and in 4 (25%) no centralizing regulations were present. The number of centers performing esophageal cancer surgery per country differed from 4 to 400, representing 0.5-4.9 centers per million inhabitants. In 4 countries (25%), esophageal cancer surgery was part of general surgical training and 8 (50%) reported the availability of upper GI surgery fellowships. A national audit for upper GI surgery was present in 8 (50%) countries. If available, all countries use the audit to monitor the quality of care. Substantial differences exist in the organization and centralization of esophageal cancer surgical care in Western Europe. The exchange of experience in the organizational aspects of care could further improve the results of esophageal cancer surgical care in Europe.

There has been a substantial increase in the use of laparoscopic sleeve gastrectomy (SG) to treat morbid obesity despite observational evidence demonstrating the superiority of Roux-en-Y gastric bypass (RYGB) for reducing low-density lipoprotein (LDL) cholesterol. The main aim was to ascertain whether high LDL cholesterol levels should be considered when selecting the most appropriate surgical procedure for each patient (RYGB or SG). In this single-center, randomized clinical trial using intention-to-treat analysis, 38 patients with severe obesity and elevated levels of LDL cholesterol were randomly assigned to undergo RYGB or SG. The primary outcome was LDL cholesterol remission at 12 months, defined as LDL cholesterol < 3.36 nmol/l without lipid-lowering medications. Secondary outcomes included changes in weight, other comorbidities, qualitative lipoprotein traits, cholesterol esters, glycoproteins, cholesterol absorption and synthesis metabolites and complications. Intention-to-treat analysis revealed that LDL cholesterol remission occurred in 66.6

Introduction The OligoMetastatic Esophagogastric Cancer (OMEC) project aims to provide clinical practice guidelines for the definition, diagnosis, and treatment of esophagogastric oligometastatic disease (OMD). Methods Guidelines were developed according to AGREE II and GRADE principles. Guidelines were based on a systematic review (OMEC-1), clinical case discussions (OMEC-2), and a Delphi consensus study (OMEC-3) by 49 European expert centers for esophagogastric cancer. OMEC identified patients for whom the term OMD is considered or could be considered. Disease-free interval (DFI) was defined as the time between primary tumor treatment and detection of OMD. Results Moderate to high quality of evidence was found (i.e. 1 randomized and 4 non-randomized phase II trials) resulting in moderate recommendations. OMD is considered in esophagogastric cancer patients with 1 organ with ≤3 metastases or 1 involved extra-regional lymph node station. In addition, OMD continues to be considered in patients with OMD without progression in number of metastases after systemic therapy. 18F-FDG PET/CT imaging is recommended for baseline staging and for restaging after systemic therapy when local treatment is considered. For patients with synchronous OMD or metachronous OMD and a DFI ≤2 years, recommended treatment consists of systemic therapy followed by restaging to assess suitability for local treatment. For patients with metachronous OMD and DFI >2 years, upfront local treatment is additionally recommended. Discussion These multidisciplinary European clinical practice guidelines for the uniform definition, diagnosis and treatment of esophagogastric OMD can be used to standardize inclusion criteria in future clinical trials and to reduce variation in treatment.

To assess the effects of Helicobacter pylori (HP) eradication with an omeprazole, clarithromycin, amoxicillin, and metronidazole (OCAM) regimen on the metabolic profile and weight loss 12 months after bariatric surgery (BS). Retrospective analysis of a prospective cohort of patients with morbid obesity undergoing BS. HP presence was tested preoperatively by gastric biopsy and treated with OCAM when positive. Short-term metabolic outcomes and weight loss were evaluated. HP infection was detected in 75 (45.7

Background: The aim of this study was to evaluate different preoperative immune, inflammatory, and nutritional scores and their best cut-off values as predictors of poorer overall survival (OS) and disease-free survival (DFS) in patients who underwent curative gastric cancer resection. Methods: This was a retrospective observational multicentre study based on data of the Spanish EURECCA Esophagogastric Cancer Registry. Time-dependent Youden index and log-rank test were used to obtain the best cut-offs of 18 preoperative biomarkers for OS and DFS. An adjusted Cox model with variables selected by bootstrapping was used to identify the best preoperative biomarkers, which were also analysed for every TNM stage. Results: High neutrophil-to-lymphocyte ratio (NLR), high monocyte systemic inflammation index (moSII), and low prognostic nutritional index (PNI) were identified as independent predictors of poor outcome: NLR > 5.91 (HR:1.73; 95%CI [1.23–2.43]), moSII >2027.12 (HR:2.26; 95%CI [1.36–3.78]), and PNI >40.31 (HR:0.75; 95%CI [0.58–0.96]) for 5-year OS and NLR > 6.81 (HR:1.75; 95%CI [1.24–2.45]), moSII > 2027.12 (HR:2.46; 95%CI [1.49–4.04]), and PNI > 40.31 (HR:0.77; 95%CI [0.60,0.97]) for 5-year DFS. These outcomes were maintained in the whole cohort for NLR and moSII (p < 0.05) but not in stage II and for PNI in all tumoral stages. The associations of NLR-PNI and moSII-PNI were also a relevant prognostic factor for OS. Conclusions: High NLR, high moSII (for stages I and III), and low PNI (regardless of tumour stage) were the most promising preoperative biomarkers to predict poor OS and DFS in gastric cancer patients treated with curative intent.