433 Background: Peritoneal metastasis (PM) from gastric cancer (GC) carries a dismal prognosis and remains refractory to systemic therapies. Oncolytic virotherapy offers a novel peritoneal-targeted approach. We evaluated the efficacy of CF33-hNIS, a chimeric orthopoxvirus, alone and in combination with anti–PD-L1 immune checkpoint blockade in an immunocompetent mouse model of gastric cancer peritoneal metastasis (GCPM). Methods: A syngeneic GCPM model was established using ACKPY3944 murine GC cells. Mice received intraperitoneal (IP) CF33-hNIS alone or in combination with intravenous (IV) or IP anti–PD-L1. Tumor regression, survival, and immune responses were assessed. Flow cytometry and immunohistochemistry characterized CD3⁺ T-cell subsets in the peritoneal cavity and tumor microenvironment. Complete tumor regression (CTR) mice were rechallenged with ACKPY3944 cells to evaluate memory T-cell responses. Results: IP CF33-hNIS monotherapy significantly prolonged survival and increased CD3⁺ and CD8⁺ T-cell infiltration in both peritoneal fluid and tumor tissue. The most effective regimen—a single high-dose CF33-hNIS (10⁸ pfu) combined with IP anti–PD-L1 (Combo 2)—achieved 75% CTR. Mice with CTR rejected tumor rechallenge and exhibited marked expansion of effector and central memory T cells in the peritoneal cavity and spleen. Conclusions: IP CF33-hNIS exerts potent anti-tumor activity in GCPM, enhanced by concurrent IP anti–PD-L1. The high-dose Combo 2 strategy induces durable tumor-specific immunity and provides strong rationale for clinical translation of simplified, peritoneal-targeted oncolytic viro-immunotherapy in gastric cancer.

BACKGROUND:Gastric cancer peritoneal metastasis (GCPM) is a common manifestation of advanced gastric cancer, associated with poor prognosis. METHODS:The International Gastric Cancer Association (IGCA) convened a multidisciplinary working group of 42 global experts from 15 countries to develop a total of 13 consensus statements addressing diagnosis, treatment, and research priorities for GCPM. Using ACcurate COnsensus Reporting Document (ACCORD)-compliant methodology, the group conducted systematic literature searches and applied a structured Delphi process with anonymous Likert-scale voting and a ≥70% consensus threshold to generate and refine consensus statements. RESULTS:Consensus was achieved for all 13 statements among the working group during the first Delphi round, with 75-100% of respondents selecting either 'strongly agree' or 'agree'. Coefficient of variation values were ≤0.23. Polling of a broader group of experts (n = 66), which included members of the working group (n = 21), during a GCPM consensus session at the 16th International Gastric Cancer Congress (IGCC) in 2025 demonstrated agreement for 12 of the 13 statements. This broader group of experts, which had greater representation from medical oncologists, did not reach consensus (52% agreement) on best practice for systemic treatment of patients with GCPM, possibly due to the rapidly evolving developments in this field of metastatic gastric cancer. CONCLUSION:This consensus exercise provides a foundation for globally relevant GCPM management strategies and highlights critical research needed to address significant evidence gaps that will improve patient outcomes.

BACKGROUND:Implementation of remote robotic-assisted surgery (rRAS) has the potential to significantly improve access to high-quality surgical care for patients worldwide. Advances in robotic systems and telecommunications now enable highly reliable, low latency, and cybersecure connectivity. These technological developments, together with the broader adoption of telemedicine, have driven an increasing interest in the implementation of rRAS. METHODS:The Clinical Robotic Surgery Association (CRSA) convened a conference to develop international clinical recommendations for rRAS using the Danish Model of Consensus. The society identified five key issue categories and invited a panel of experts to address specific questions for each. Panel members and a jury of 10 unbiased, non-expert in rRAS professionals participated in a day-long conference on November 19, 2025 (Los Angeles, USA). During the conference, participants presented, discussed, and reached consensus on specific guidelines relevant to each category. Immediately after the conference, the jury reviewed and approved the recommended guidelines. RESULTS:Multiple recommendations were approved for each of the following categories: Operating Models, Roles and Responsibilities (2 recommendations), Clinical Pathway (2 recommendations), Emergency Management (8 recommendations), Technical Considerations (5 recommendations), and Medico-legal and Ethical Considerations (4 recommendations). CONCLUSIONS:There was consensus that with recent advances in telecommunication and robotic technologies, rRAS can be offered safely and effectively if the identified safeguards are realized. Adoption of rRAS is expected to continue advancing rapidly.

The benefit of surgical resection in addition to systemic therapy in patients with gastric/gastroesophageal cancer and peritoneal metastases (GCPM) is controversial. This CONVERGENCE trial aims to study the potential benefits of conversion surgery in patients with peritoneal metastases. This is a prospective, pragmatically designed, multicentre, randomized, investigator-initiated phase II/III trial. Patients with synchronous GCPM who have undergone either systemic therapy (including 1 L chemotherapy +/- targeted therapy +/- immunotherapy) +/- peritoneal directed chemotherapy with favourable response would be randomized in 1:1 ratio to Arm 1 (Conversion surgery followed by systemic +/- peritoneal directed chemotherapy or Arm 2 (continual systemic +/- peritoneal directed chemotherapy). In the initial Phase II trial, 136 patients will be recruited and randomized. The primary endpoint is overall survival; main secondary endpoints include progression-free survival, R0 resection and complete cytoreduction rates, surgical morbidity/mortality and quality of life outcomes. If pre-defined thresholds of improved overall survival are met, the trial will expand to adequately power a phase III randomized controlled trial (n = 300). If survival benefit in conversion gastrectomy is demonstrated, this could potentially be a new standard of care for patients with peritoneal metastases from gastric or gastroesophageal junction cancer. Conversely, negative findings may lead to the avoidance of unnecessary surgical procedures and morbidity in these patients. NCT07241715.

Peritoneal metastasis (PM) is the leading cause of treatment failure and death from gastric cancer (GC). We evaluated the antitumor and immunogenic effects of CF17, an oncolytic chimeric orthopoxvirus, in a novel syngeneic mouse model of GCPM. CF17 was tested in mouse GC cell lines (ACKPY3944 and ACKPY4113) for viral replication and cytotoxicity. A syngeneic mouse model of PM was established in C57BL/6 mice via intraperitoneal (IP) implantation of 1 × 106 ACKPY3944-ffluc cells. Mice were treated with either IP CF17 or PBS. Peritoneal tumor burden was monitored by bioluminescence imaging. Immune profiles of peritoneal washings and tumors were assessed by flow cytometry and immunohistochemistry. CF17 infected, replicated in, and killed ACKPY3944 and ACKPY4113 cells in vitro. Mice treated with IP CF17 showed a significant decrease in tumor burden (p < 0.05) and prolonged survival (p < 0.001). CF17 treatment significantly enhanced leukocyte infiltration, including CD4+ and CD8+ cells, into the tumor microenvironment of the peritoneal cavities and solid tumors. Overall, these results demonstrate that CF17 has potent anti-tumor activity and immunogenicity in a syngeneic mouse model of GCPM. These data provide a framework to support future studies to optimize CF17-based immunotherapeutic approaches for GCPM.

Background Peritoneal metastasis (PM) from gastric cancer (GC) is associated with poor prognosis and limited treatment options. We investigated a novel peritoneal-targeted therapy using CF33-human sodium iodide symporter (hNIS), a chimeric orthopoxvirus, combined with anti-PD-L1 immune checkpoint blockade in an immunocompetent mouse model of GCPM.Methods We evaluated replication and cytotoxicity of CF33-hNIS in human and murine GC cell lines. We assessed a syngeneic mouse model of PM using the transgenic mouse GC ACKPY3944 cells to test the efficacy of intraperitoneal (IP) CF33-hNIS alone and combined with intravenous or IP anti-PD-L1. Next, we performed flow cytometry and immunohistochemistry to analyze immune cell populations of CD3+ T cell subsets in the peritoneal cavity and tumor microenvironment. Mice that showed complete tumor regression (CTR) were rechallenged with ACKPY3944 cells to assess memory T cell responses.Results CF33-hNIS efficiently infected and killed GC cells. In vivo, IP CF33-hNIS alone significantly prolonged survival and increased infiltration of CD3+ and CD8+ T cells within the peritoneal cavity and solid tumor. The most pronounced therapeutic effect was observed with a single high-dose of CF33-hNIS (108 plaque-forming units) combined with IP anti-PD-L1 (Combo 2) with 75% CTR. Notably, mice with CTR rejected tumor rechallenge, exhibiting significantly elevated effector and central memory T cell populations in the peritoneal cavity and spleen. IP CF33-hNIS demonstrates robust anti-tumor efficacy against GCPM, particularly when combined with IP anti-PD-L1 in the high-dose Combo 2 regimen.Conclusions These findings support a simplified, high-dose IP treatment strategy to overcome immune resistance in GCPM and provide a strong rationale for future clinical evaluation.

Abstract Malignant ascites (MA) remains a severe, untreatable complication in patients with late-stage cancers including pancreatic cancer, contributing to their poor prognosis. Using single-cell RNA sequencing (scRNA-seq), we characterized 12,084 cells isolated in MA samples from patients with pancreatic cancer. We found that immune cells were the dominant (90%) cell population with M2-like macrophages (62.4%) and T cells (23.1%) prevailing, while tumor cells constituted only 7.5% of the total cell population. The M2-like macrophages, marked by high CD163 and low CD80 expression, expressed elevated vascular endothelial growth factor (VEGF) and colony-stimulating factor-1 receptor (CSF1R), potentially promoting tumor proliferation, survival, and ascites formation via increased endothelial permeability. The T cells were mostly CD8-negative, indicating suppressed cytotoxic function, consistent with findings in ovarian cancer ascites. We hypothesize that targeting VEGF, CSF1R, and immune checkpoint proteins (e.g., PD-1 and CTLA-4) can reprogram the MA immune microenvironment, reducing ascites and peritoneal tumor growth. To test this hypothesis, we established an MA model for pancreatic cancer by intraperitoneally implanting murine pancreatic cancer cells derived from the KPC model into C57BL/6 mice. These mice develop ascites 7-10 days after cell injection and succumb to the disease within 4-5 weeks. We then evaluated the activity of anti-PD-1 and anti-CTLA-4 antibodies as a single agent or in combination in the KPC MA model. Both antibodies significantly reduced the formation of MA and extended the survival of the mice. The anti-PD-1 antibody (300 µg/dose for 3 weekly doses) extended the median survival from 25 days in the isotype control antibody group to 55 days, while the median survivals for both the anti-CTLA-4 group (100 µg/dose for 3 weekly doses) and the combination group were not reached 96 days after the initiation of treatment. We are in the process of assessing the efficacy of an anti-VEGFA antibody (2G11-2A05) and a CSF1R inhibitor (PLX3397) in the same model. Results from the studies could establish preclinical evidence supporting the utility of these novel therapeutic regimens for treating MA in pancreatic cancer patients and lead to clinical trials to address this critical unmet need. Citation Format: Kuntal Halder, Ruben Munoz, Wei Lin, Annie Yang, Yanghee Woo, Erkut Borazanci, Haiyong Han, Daniel D Von Hoff. Novel targeted therapies for malignant ascites in pancreatic cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 2226.

Neoadjuvant therapy is a cornerstone of treatment for resectable gastroesophageal junction (GEJ) tumors. Despite substantial advancements, optimal regimen selection remains challenging owing to heterogeneity in clinical trial inclusion criteria and treatment algorithms. This review synthesizes findings from pivotal randomized trials to guide evidence-based selection of neoadjuvant treatment for GEJ adenocarcinoma. In 2006, the MAGIC trial established a survival benefit with perioperative chemotherapy with epirubicin, cisplatin, and fluorouracil (ECF) compared with surgery alone. Subsequently, in 2012, CROSS demonstrated improved overall survival (OS) and R0 resection rates with neoadjuvant chemoradiotherapy (CRT) using carboplatin and paclitaxel compared with surgery alone. CRT increased pathologic complete response (pCR) rates and decreased local recurrence rates, though it had limited impact on distant recurrence rates. In 2018, the FLOT4 trial demonstrated that perioperative FLOT (fluorouracil, leucovorin, oxaliplatin, docetaxel) improved overall survival and pCR rates compared with ECF, making FLOT the new standard for perioperative chemotherapy. Several trials have since compared perioperative chemotherapy with neoadjuvant CRT. Neo-AEGIS found no survival difference; however, the predominance of ECF rather than FLOT in the chemotherapy arm limits its pertinence in the modern era. TOPGEAR demonstrated improved pCR with the addition of preoperative radiotherapy to FLOT, but no survival advantage. More recently, ESOPEC established FLOT's superiority over CROSS for OS, and MATTERHORN demonstrated improved event-free survival with the addition of immunotherapy to perioperative FLOT. FLOT is the current standard for neoadjuvant treatment in GEJ adenocarcinoma due to its superior survival outcomes. Integration of immunotherapy represents a promising avenue to further improve outcomes.

432 Background: Gastric cancer peritoneal metastasis (GCPM) has limited therapeutic options and dismal prognosis. Oncolytic virotherapy (OVT) efficacy is critically shaped by its interaction with TAMs. CF33, a novel chimeric orthopoxvirus, demonstrates cytotoxicity against gastric cancer (GC) cells, but its effects on M2-polarized tumor-associated macrophages (TAMs)—the dominant immune-suppressive component of the peritoneal tumor microenvironment (TME)—remain poorly defined. Methods: Patient-derived ascitic cells from GCPM were treated with CF33-GFP and analyzed by flow cytometry. Human PBMC-derived M2 macrophages were exposed to CF33-OVs to assess viral infection/replication, cytotoxicity, death pathways, and M2→M1 phenotypic switching, using annexin V/PI staining, microscopy, MTS assays, TEM, western blotting, RNA-seq, cytokine multiplexing, and migration assays. In vivo effects were validated in a syngeneic mouse model of GCPM (ACKPY3944), with TAM modulation assessed by flow cytometry and immunohistochemistry. Results: CF33-OVs selectively infected and replicated in M2 macrophages, inducing CELL death through intrinsic apoptotic and autophagic pathways, with activation of p-TBK1, p-Akt, p38 MAPK, and CDK4/6 signaling. RNA-seq revealed reprogramming of M2 macrophages toward an M1 phenotype, accompanied by upregulation of pro-inflammatory cytokines/chemokines and enhanced immune cell migration. Ex vivo, CF33-OVs eliminated TAMs in patient-derived ascites, and in vivo, CF33-hNIS effectively depleted TAMs in peritoneal cavity of syngeneic GCPM tumors. Conclusions: CF33-hNIS directly targets and eliminates TAMs while reprogramming the peritoneal TME from immunosuppressive (“cold”) to immune-active (“hot”). By simultaneously killing GC cells and remodeling TAM biology, CF33-hNIS enhances anti-tumor immunity and represents a promising therapeutic strategy for GCPM.

413 Background: The role of neoadjuvant chemotherapy (NAC) in resectable, locally advanced gastric cancer is debated, with wide variation in adoption between Asian and Western countries. The impact of these diverse practices on perioperative and long-term outcomes is not well defined. Methods: We analyzed 23,805 patients who underwent resection from 10 high-volume gastric cancer centers across Asia, Europe and North America from January 3, 2005 to March 11, 2024. Patients with ≥T2 tumors undergoing radical gastrectomy with or without NAC were compared. Propensity score matching (3:1) adjusted for age, comorbidity, clinical stage, and histology. Results: After matching 1,017 patients (353 NAC, 664 non-NAC) were evaluated. In the West FLOT was the most common regimen (56.3%), while the East had more variability but overall used a combination of taxane and platinum agent (63.5%), with SOX being most common (17.9%). NAC patients more often underwent total gastrectomy (31.2% vs 23.5%, p<0.001), a more extensive lymph node dissection with D2 (62.7% vs 51.9%, p<0.001), and conversion to open surgery (2.93% vs 0.7%, p=0.008). NAC down staged tumors, with fewer pT4a tumors (14.0% vs 20.7%, p<0.001), and more T0 tumors (4.58% vs 0%, p<0.001). Despite these effects, pathologic nodal stage and margin status were similar; and the perioperative-hospital mortality (0.34% vs 0%, p=0.182) and complication rates did not differ. Moreover, overall recurrence rates (19.9% vs 16.4%, p=0.176) also did not differ. Interestingly, NAC patients more often recurred in the peritoneum (57.1% vs 36.4%, p=0.03) and less often in distant sites (8.2% vs 25.85%, p=0.03). Median follow up was 36.4 months (range 0.16 to 144.4 months). Median disease-free survival (10.1 vs 10.6 months, p=0.29) and overall survival (14.5 vs 17.8 months, p=0.61) were similar. Conclusions: In one of the largest and most ethnically diverse international propensity-matched analyses to date, NAC achieved tumor downstaging but did not improve disease-free or overall survival compared to upfront surgery. Distinct recurrence patterns after NAC highlight biological heterogeneity, underscoring the need for tailored strategies to optimize timing systemic therapy in locally advanced gastric cancer. Global real-life oncologic outcomes of NAC versus non-NAC in locally advanced gastric cancer patients at high-volume centers. Non-NACn = 664 NACn = 353 p-value Recurrence, n (%) 106 (16.4) 68 (19.9) 0.176 Recurrence location, n (%) 0.030 Peritoneum 24 (36.4) 28 (57.1) Distant 17 (25.8) 4 (8.2) Local 3 (4.6) 2 (4.1) Distant lymph node 14 (21.2) 7 (14.3) Multiple 5 (7.6) 8 (16.3) Overall survival median, months (IQR) 17.8 (11.5 - 24.4) 14.5 (8.2 - 21.4) 0.613 Disease free survival median, months (IQR) 10.6 (5.7 - 18.8) 10.1 (5.9 - 16.5) 0.286 IQR: Interquartile range, NAC: Neoadjuvant chemotherapy.

Lymphadenectomy (LND) is a crucial component of the curative surgical treatment of gastric cancer (GC). The LND serves to both accurately stage the disease and offer therapeutic benefits. At the time of "curative-intent" gastrectomy, D2 LND is the optimal treatment for patients with locally advanced GC due to its survival benefits and acceptable morbidity. Mastery of the technical aspects of LND, especially D2, requires significant training, adequate case volume, and expertise. This review discusses key aspects of D2 LND, including its status as the standard treatment for locally advanced GC, definition and anatomic borders, technical details, and controversial topics such as splenic hilar dissection and omentectomy. The application of indocyanine green (ICG) fluorescence imaging to elucidate the drainage patterns of GC and to facilitate lymph node (LN) identification is briefly reviewed. Finally, GC standardization and centralization, including surgical treatment, are discussed.

OBJECTIVE:To determine whether perioperative monitoring with nursing triage intervention is feasible and improves surgical outcomes and recovery. BACKGROUND:There are increased demands for outpatient recovery after complex gastrointestinal oncologic surgery with simultaneous expectations of improving quality of life and expedited functional recovery. Telemonitoring is a proposed mechanism to achieve these goals. METHODS:This prospective randomized controlled trial was conducted at a single institution from October 2021 to July 2023, and follow-up was completed in August 2023. Adult patients undergoing gastrointestinal oncologic surgery were randomized to either the telemonitoring intervention arm or the enhanced usual care control arm. Patient-generated health data (PGHD) and electronic patient-reported outcomes (ePROs) were assessed at discharge, 2 days, 7 days, 14 days, and 30 days postdischarge. The telemonitoring intervention arm additionally received nursing triage support when PGHD deviated from defined thresholds. RESULTS:A total of 129 participants [median (IQR) age, 53 (47-65); 43% female] were randomized. Fifty (39%) lived >50 miles from the medical center. Overall attrition was 12%, and there were no differences in feasibility, retention, or acceptability between arms. Postoperative complications and readmission rates were similar between arms. The intervention arm reported significantly lower MD Anderson Symptom Inventory (MDASI) interference with activity and symptom severity scores at multiple time points compared with the control arm ( P <0.05). CONCLUSIONS:This trial demonstrates that perioperative telemonitoring is feasible and acceptable. Improved ePROs in the intervention arm suggests that nursing triage intervention may help augment postoperative recovery.

PET imaging at different time points

Background: Gastric cancer (GC) remains a significant health burden in the U.S, particularly among ethnic minorities. We identified patient-level risk factors contributing to advanced-stage (AS) diagnosis and poor survival to guide strategies to address GC-related health disparities. Methods: We conducted a retrospective cohort analysis of 18,396 histologically confirmed GC cases (4102 early-stage (ES) and 14,294 AS) diagnosed between 2000 and 2019, using data from the California Cancer Registry linked to the California Office of Statewide Health Planning and Development. Eligible cases were adults age ≥ 18 with complete diagnostic and follow-up data. Multivariable logistic and Cox regression models were used to identify predictors of AS-GC and five-year disease-specific (DSS) and overall-survival (OS) outcomes. Analyses were further stratified by Asian and Hispanic subgroups. Results: Korean heritage was the strongest predictor of ES-GC [OR 0.58 (95% CI, 0.47–0.71), p < 0.001] and was independently associated with the lowest GC-specific mortality risk [HR 0.73 (95% CI: 0.67–0.80), p < 0.0001]. The youngest age group (18–44 years) had the highest AS-GC rate (91.4%). Asian ethnicity, receipt of care at NCI-designated cancer centers, and prior upper endoscopy were associated with improved OS and DSS. In contrast, comorbidities such as GERD, diabetes, liver disease, smoking and alcohol abuse, and older age ≥ 75, U.S.-birth, and rural residence were linked to worse outcomes. Conclusions: Distinct demographic, clinical, and healthcare access factors contribute to disparities in GC outcomes. These findings support the development of culturally tailored early-detection programs, and risk-based screening for GC care, particularly in vulnerable populations.

Pancreatic ductal adenocarcinoma (PDAC) is characterized by a tumor-protective immune microenvironment that limits the efficacy of current immunotherapeutic agents, underscoring the need for novel strategies. We previously demonstrated that CF33-hNIS-antiPDL1 possesses potent oncolytic properties against human PDAC in vitro and in immunocompromised mouse models. In this study, we investigated the immunogenic properties and therapeutic efficacy of CF33 derivatives in murine pancreatic cancer KPC cells in vitro and in an orthotopic syngeneic mouse model. CF33 derivatives replicated in and killed KPC cells in a dose- and time-dependent manner. KPC cells stained negative for surface PD-L1 but positive for intracellular PD-L1. Treatment with IFNγ and IFNβ1, cytokines involved in viral response and immune regulation, significantly upregulated cell surface PD-L1 expression on KPC cells. Notably, infected KPC cells produced virus-encoded anti-PD-L1 single-chain variable fragment (scFv) that blocked IFNγ/β1-induced surface PD-L1 binding. In vivo, intraperitoneal administration of CF33-hNIS-antiPDL1 significantly prolonged survival in mice bearing orthotopic KPC tumors. This benefit was associated with a notable increase in CD45+ leukocytes and CD8+ T cells. In conclusion, CF33-hNIS-antiPDL1 showed both immunogenic and anti-tumor activity against mouse KPC cells in vitro and in vivo, with functional expression of active anti-PD-L1 scFv. These findings support the clinical translation of CF33-hNIS-antiPDL1 as an intraperitoneal therapy in PDAC patients.

INTRODUCTION:Advances in robotic instrumentation have facilitated minimally invasive completion of complex cancer operations. The objective of this study is to determine the feasibility of robotic approach for cytoreduction (R-CRS) for peritoneal carcinomatosis in a series of 16 consecutive cases. METHODS:Single institution retrospective study of consecutive patients with peritoneal carcinomatosis deemed appropriate for R-CRS after multidisciplinary review between 2017 and 2022. Feasibility was defined as the proportion of patients in whom complete cytoreduction was achieved without conversion to open. RESULTS:A total of 16 patients (median interquartile range [IQR]: age 60 ys [45.8-70.5], body mass index 29 [24.5-33.6], peritoneal carcinomatosis index 5 [2.8-6.3]) underwent R-CRS of which six also received hyperthermic intraperitoneal chemtotherapy. Seven patients had gastrointestinal primary cancers (3 colorectal, 3 appendiceal, 1 small bowel neuroendocrine); and nine had gynecologic cancers (7 ovarian, 2 endometrial). Median operative time was 6.0 h (IQR: 5.0-9.0), and median estimated blood loss was 87.5 mL (IQR: 30.0-262.5). Robotic procedures included: pelvic tumor debulking 12 (75%), omentectomy 8 (50%), peritonectomy 6 (38%), large bowel resection 6 (37%), retroperitoneal mass resection 4 (25%), and hepatectomy 3 (19%). Median length of stay was 3.5 ds (IQR: 1.8-5.3) for the whole cohort and only 2 ds (IQR: 1.0-5.5) for patients who did not undergo hyperthermic intraperitoneal chemotherapy. Feasibility rate was 87.5%, whereas conversion, 30-d complication, and 30-d mortality rates were 12.5%, 18.8%, and 0%, respectively. CONCLUSIONS:Our experience with R-CRS demonstrates feasibility of the approach with a potential for benefit in short-term outcomes in a carefully selected cohort of patients when performed at a high-volume robotic surgery center.

Gastric cancer is the fifth leading cause of cancer-related deaths worldwide. Over 95% of gastric cancers are adenocarcinomas, which are typically classified based on anatomic location and histologic type. Gastric cancer generally carries a poor prognosis because it is often diagnosed at an advanced stage. Systemic therapy can provide palliation, improve survival, and enhance the quality of life in patients with locally advanced or metastatic disease. The implementation of biomarker testing has had a significant impact on clinical practice and patient care. Targeted therapies have demonstrated encouraging results in clinical trials for the treatment of patients with locally advanced or metastatic disease. This selection from the NCCN Clinical Practice Guidelines in Oncology for Gastric Cancer highlights recommendations for biomarker testing and discusses updates for the treatment of advanced disease, including peritoneal carcinoma as only disease and unresectable locally advanced, recurrent, or metastatic disease.