2025 Edition of CACA Integrated Guidelines for the Diagnosis and Treatment of Gastric Cancer—interpretation of the surgery and perioperative treatment section_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LIANG Han , LI Bin

Department of Gastric Surgery, Tianjin Medical University Cancer Institute & Hospital; National Clinical Research Center for Cancer; Tianjin Clinical Research Center for Cancer; Tianjin Key Laboratory of Digestive System Tumors, Tianjin 300060, P. R. China;

Corresponding?author：

LIANG Han, Email: tjlianghan@126.com

Keywords：

gastric cancer; guideline; laparoscopy; neoadjuvant therapy; immunotherapy

DOI：

10.7507/1007-9424.202604042

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Pathological and molecular testing of gastric cancer is a prerequiste for precise treatment. Routine testing for human epidermal growth factor receptor 2 (HER2), microstatellite instability/mismach repair, programmed cell death ligand 1 combined positive score, Claudin18.2 are recommended. Locally advanced gastric cancer progress to metastasis or positive free cancer cells in abdoimnal cavity is greater than 20%, laparoscopic exploration and staging is recommended before neoadjuvant therapy. Positive free cancer cells in the peritoneal cavity are one of the main forms of peritoneal metastasis in gastric cancer. Rapid frozen section examination of peritoneal lavage fluid can significantly increase the positive rate. Accurate ex vivo dissection of lymph nodes after D2 radical gastrectomy is an important meansure to ensure surgical quality, precisely evaluate prognosis, and formulate individualized adjuvant therapy regimens. Perioperative SOX chemotherapy for locally advanced gastric cancer has become a Chinese paradigm, and perioperative immunotherapy has emerged as a new standard. Preliminary results have also been achieved in the exploration of neoadjuvant target-immuno-chemotherapy for HER2 positive locally advanced gastric cancer, as well as neoadjuvant therapy with bispecific antibody (AK104) combined with SOX for HER2 negative gastric cancer. For advanced gastric cancer with peritoneal metastasis, paclitaxel dual-path chemotherapy can improve the R0 resection conversion rate and long-term survival of patients. For patients with potentially resectable gastric cancer with liver metastasis, active comprehensive treatment based on multidisciplinary team model an significantly imporve the R0 resection conversion rate. Target-immuno-chemotherapy for conversion therapy in stage Ⅳ gastric cancer can significantly improve the pathological complete response rate and long-term survival of patients after conversion surgery.

Citation： LIANG Han, LI Bin. 2025 Edition of CACA Integrated Guidelines for the Diagnosis and Treatment of Gastric Cancer—interpretation of the surgery and perioperative treatment section. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(5): 629-634. doi: 10.7507/1007-9424.202604042 Copy

1.	Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent, 2024, 4(1): 47-53.
2.	中國抗癌協會胃癌專業委員會. 2024版CACA胃癌整合診治指南(精簡版). 中國腫瘤臨床, 2024, 51(13): 650-657.
3.	中國抗癌協會胃癌專業委員會. 胃癌抗HER2治療中國專家共識(2024年版). 中國腫瘤臨床, 2024, 51(23): 1189-1205.
4.	Shitara K, Shah MA, Lordick F, et al. Zolbetuximab in gastric or gastroesophageal junction adenocarcinoma. N Engl J Med, 2024, 391(12): 1159-1162.
5.	Deng J, Liu J, Wang W, et al. Validation of clinical significance of examined lymph node count for accurate prognostic evaluation of gastric cancer for the eighth edition of the American Joint Committee on Cancer (AJCC) TNM staging system. Chin J Cancer Res, 2018, 30(5): 477-491.
6.	中國抗癌協會胃癌專業委員會, 中華醫學會腫瘤學分會胃腸學組, 中國醫師協會外科醫師分會腫瘤外科醫師委員會. 胃癌根治標本規范化淋巴結送檢操作中國專家共識(2019版). 中國實用外科雜志, 2019, 39(9): 881-889.
7.	張楠楠, 鄧靖宇, 何文婷, 等. 727例胃癌根治術標本淋巴結精細分檢的臨床價值探討. 中國腫瘤臨床, 2019, 46(1): 22-27.
8.	Zhao L, Chen Z, Zhang F, et al. Changing landscape in stage, treatment and survival of gastric cancer in China 1998-2022: insights of 40, 158 patients from the National Gastric Cancer Cohort. Cancer Lett, 2026, 642: 218261. doi: 10.1016/j.canlet.2026.218261.
9.	中國抗癌協會胃癌專業委員會. 胃癌腹膜轉移診治中國專家共識(2023版). 中華胃腸外科雜志, 2023, 26(8): 717-728.
10.	Li Z, Li Z, Zhang L, et al. Staging laparoscopy for locally advanced gastric cancer in Chinese patients: a multicenter prospective registry study. BMC Cancer, 2018, 18(1): 63. doi: 10.1186/s12885-017-3791-6.
11.	Zhu Z, Kitayama J, Kim HH, et al. Asian consensus on normothermic intraperitoneal and systemic treatment for gastric cancer with peritoneal metastasis. Gastric Cancer, 2025, 28(5): 731-748.
12.	國際食管疾病學會中國分會(CSDE)食管胃結合部疾病跨界聯盟, 中國醫師協會內鏡醫師分會腹腔鏡外科專業委員會, 中國醫師協會外科醫師分會上消化道外科醫師專業委員會, 等. 食管胃結合部腺癌外科治療中國專家共識(2018年版). 中華胃腸外科雜志, 2018, 21(9): 961-975.
13.	中國抗癌協會胃癌專業委員會. 局部進展期胃癌規范化淋巴結清掃范圍中國專家共識(2022版). 中華胃腸外科雜志, 2022, 25(4): 277-283.
14.	Liang Y, Wu L, Wang X, et al. Positive impact of adding No. 14v lymph node to D2 dissection on survival for distal gastric cancer patients after surgery with curative intent. Chin J Cancer Res, 2015, 27(6): 580-587.
15.	Wu L, Zhang C, Liang Y, et al. Risk factors for metastasis to No. 14v lymph node and prognostic value of 14v status for gastric cancer patients after surgery. Jpn J Clin Oncol, 2018, 48(4): 335-342.
16.	Tsuburaya A, Mizusawa J, Tanaka Y, et al. Neoadjuvant chemotherapy with S-1 and cisplatin followed by D2 gastrectomy with para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis. Br J Surg, 2014, 101(6): 653-660.
17.	Zheng CH, Chen YB, Yu WB, et al. Safety and efficacy of indocyanine green-guided laparoscopic lymphadenectomy for locally advanced gastric cancer: the CLASS-11 clinical trials. Cell Rep Med, 2025, 6(5): 102136. doi: 10.1016/j.xcrm.2025.102136.
18.	Lu J, Zheng CH, Xu BB, et al. Assessment of robotic versus laparoscopic distal gastrectomy for gastric cancer: a randomized controlled trial. Ann Surg, 2021, 273(5): 858-867.
19.	Chen QY, Zhong Q, Liu ZY, et al. Indocyanine green fluorescence imaging-guided versus conventional laparoscopic lymphadenectomy for gastric cancer: long-term outcomes of a phase 3 randomised clinical trial. Nat Commun, 2023, 14(1): 7413. doi: 10.1038/s41467-023-42712-6.
20.	Zhang X, Liang H, Li Z, et al. Perioperative or postoperative adjuvant oxaliplatin with S-1 versus adjuvant oxaliplatin with capecitabine in patients with locally advanced gastric or gastro-oesophageal junction adenocarcinoma undergoing D2 gastrectomy (RESOLVE): final report of a randomised, open-label, phase 3 trial. Lancet Oncol, 2025, 26(3): 312-319.
21.	Janjigian YY, Shitara K, Ajani JA, et al. Nivolumab plus chemotherapy as first-line treatment for advanced gastric, gastroesophageal junction, and esophageal adenocarcinoma: 5-year follow-up results from CheckMate 649. Ann Oncol, 2026, S0923-7534.
22.	Janjigian YY, Al-Batran SE, Wainberg ZA, et al. Perioperative durvalumab in gastric and gastroesophageal junction cancer. N Engl J Med, 2025, 393(3): 217-230.
23.	Ding X, Chai J, Wang X, et al. Perioperative sintilimab plus oxaliplatin and S-1 (SOX) versus SOX alone in resectable locally advanced gastric cancer/gastroesophageal junction cancer (GC/GEJC): a multicenter randomized phase Ⅱ study (PERSIST). Ann Oncol, 2025,36: Suppl 2, S1113-S1114. doi: 10.1016/j.annonc.2025.08.2738.
24.	Peng Z, Zhang X, Liang H, et al. Atezolizumab and trastuzumab plus chemotherapy for ERBB2-positive locally advanced resectable gastric cancer: a randomized clinical trial. JAMA Oncol, 2025, 11(6): 619-624.
25.	Li B, Ma J, Zhao Q, et al. Cadonilimab (cado) plus oxaliplatin and tegafur-gimeracil-oteracil potassium (SOX) in resectable gastric and gastroesophageal junction (G/GEJ) adenocarcinoma: a phase Ⅱ study (Compassion-25). Ann Oncol, 2025, 36, suppl 4: S1858. doi: 10.1016/j.annonc.2025.10.128.
26.	Yoshida K, Yamaguchi K, Okumura N, et al. Is conversion therapy possible in stage Ⅳ gastric cancer: the proposal of new biological categories of classification. Gastric Cancer, 2016, 19(2): 329-338.
27.	Yoshida K, Yasufuku I, Terashima M, et al. International retrospective cohort study of conversion therapy for stage Ⅳ gastric cancer 1 (CONVO-GC-1). Ann Gastroenterol Surg, 2021, 6(2): 227-240.
28.	中國抗癌協會胃癌專業委員會, 中國醫師協會外科醫師分會上消化道外科醫師專家工作組, 中國老年保健協會消化系統疾病診療分會, 等. 胃癌肝轉移診斷與綜合治療中國專家共識(2026版). 中國實用外科雜志, 2026, 46(2): 153-161.
29.	Yan C, Yang Z, Shi Z, et al. Intraperitoneal and intravenous paclitaxel plus S-1 versus intravenous paclitaxel plus S-1 in gastric cancer patients with peritoneal metastasis: results from the multicenter, randomized, phase 3 DRAGON-01 trial. J Clin Oncol, 2025, 43, suppl 4, 327. doi: 10.1200/JCO.2025.43.4_suppl.327.
30.	Liu Y, Xue Q, Wang B, et al. Conversion therapy with sintilimab combined with chemotherapy and apatinib in stage Ⅳ gastric cancer. Int J Cancer, 2025, 157(8): 1637-1647.
31.	中國抗癌協會胃癌專業委員會. 中國抗癌協會胃癌專委會發展歷程回顧-砥礪奮進40載. 北京: 北京大學醫學出版社, 2022.
32.	Allemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet, 2018, 391(10125): 1023-1075.
33.	梁寒. 中國胃癌外科30年發展實現跨越式國際領先. 中華胃腸外科雜志, 2025, 28(6): 688-692.
34.	Chen Y, Jia K, Xie Y, et al. The current landscape of gastric cancer and gastroesophageal junction cancer diagnosis and treatment in China: a comprehensive nationwide cohort analysis. J Hematol Oncol, 2025, 18(1): 42. doi: 10.1186/s13045-025-01698-y.
35.	周慧君, 魏麗娟, 王偉平, 等. 基于單中心醫院腫瘤登記的2019年惡性腫瘤患者5年生存報告. 中國腫瘤臨床, 2026, 53(6): 1-8.

1. Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent, 2024, 4(1): 47-53.
2. 中國抗癌協會胃癌專業委員會. 2024版CACA胃癌整合診治指南(精簡版). 中國腫瘤臨床, 2024, 51(13): 650-657.
3. 中國抗癌協會胃癌專業委員會. 胃癌抗HER2治療中國專家共識(2024年版). 中國腫瘤臨床, 2024, 51(23): 1189-1205.
4. Shitara K, Shah MA, Lordick F, et al. Zolbetuximab in gastric or gastroesophageal junction adenocarcinoma. N Engl J Med, 2024, 391(12): 1159-1162.
5. Deng J, Liu J, Wang W, et al. Validation of clinical significance of examined lymph node count for accurate prognostic evaluation of gastric cancer for the eighth edition of the American Joint Committee on Cancer (AJCC) TNM staging system. Chin J Cancer Res, 2018, 30(5): 477-491.
6. 中國抗癌協會胃癌專業委員會, 中華醫學會腫瘤學分會胃腸學組, 中國醫師協會外科醫師分會腫瘤外科醫師委員會. 胃癌根治標本規范化淋巴結送檢操作中國專家共識(2019版). 中國實用外科雜志, 2019, 39(9): 881-889.
7. 張楠楠, 鄧靖宇, 何文婷, 等. 727例胃癌根治術標本淋巴結精細分檢的臨床價值探討. 中國腫瘤臨床, 2019, 46(1): 22-27.
8. Zhao L, Chen Z, Zhang F, et al. Changing landscape in stage, treatment and survival of gastric cancer in China 1998-2022: insights of 40, 158 patients from the National Gastric Cancer Cohort. Cancer Lett, 2026, 642: 218261. doi: 10.1016/j.canlet.2026.218261.
9. 中國抗癌協會胃癌專業委員會. 胃癌腹膜轉移診治中國專家共識(2023版). 中華胃腸外科雜志, 2023, 26(8): 717-728.
10. Li Z, Li Z, Zhang L, et al. Staging laparoscopy for locally advanced gastric cancer in Chinese patients: a multicenter prospective registry study. BMC Cancer, 2018, 18(1): 63. doi: 10.1186/s12885-017-3791-6.
11. Zhu Z, Kitayama J, Kim HH, et al. Asian consensus on normothermic intraperitoneal and systemic treatment for gastric cancer with peritoneal metastasis. Gastric Cancer, 2025, 28(5): 731-748.
12. 國際食管疾病學會中國分會(CSDE)食管胃結合部疾病跨界聯盟, 中國醫師協會內鏡醫師分會腹腔鏡外科專業委員會, 中國醫師協會外科醫師分會上消化道外科醫師專業委員會, 等. 食管胃結合部腺癌外科治療中國專家共識(2018年版). 中華胃腸外科雜志, 2018, 21(9): 961-975.
13. 中國抗癌協會胃癌專業委員會. 局部進展期胃癌規范化淋巴結清掃范圍中國專家共識(2022版). 中華胃腸外科雜志, 2022, 25(4): 277-283.
14. Liang Y, Wu L, Wang X, et al. Positive impact of adding No. 14v lymph node to D2 dissection on survival for distal gastric cancer patients after surgery with curative intent. Chin J Cancer Res, 2015, 27(6): 580-587.
15. Wu L, Zhang C, Liang Y, et al. Risk factors for metastasis to No. 14v lymph node and prognostic value of 14v status for gastric cancer patients after surgery. Jpn J Clin Oncol, 2018, 48(4): 335-342.
16. Tsuburaya A, Mizusawa J, Tanaka Y, et al. Neoadjuvant chemotherapy with S-1 and cisplatin followed by D2 gastrectomy with para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis. Br J Surg, 2014, 101(6): 653-660.
17. Zheng CH, Chen YB, Yu WB, et al. Safety and efficacy of indocyanine green-guided laparoscopic lymphadenectomy for locally advanced gastric cancer: the CLASS-11 clinical trials. Cell Rep Med, 2025, 6(5): 102136. doi: 10.1016/j.xcrm.2025.102136.
18. Lu J, Zheng CH, Xu BB, et al. Assessment of robotic versus laparoscopic distal gastrectomy for gastric cancer: a randomized controlled trial. Ann Surg, 2021, 273(5): 858-867.
19. Chen QY, Zhong Q, Liu ZY, et al. Indocyanine green fluorescence imaging-guided versus conventional laparoscopic lymphadenectomy for gastric cancer: long-term outcomes of a phase 3 randomised clinical trial. Nat Commun, 2023, 14(1): 7413. doi: 10.1038/s41467-023-42712-6.
20. Zhang X, Liang H, Li Z, et al. Perioperative or postoperative adjuvant oxaliplatin with S-1 versus adjuvant oxaliplatin with capecitabine in patients with locally advanced gastric or gastro-oesophageal junction adenocarcinoma undergoing D2 gastrectomy (RESOLVE): final report of a randomised, open-label, phase 3 trial. Lancet Oncol, 2025, 26(3): 312-319.
21. Janjigian YY, Shitara K, Ajani JA, et al. Nivolumab plus chemotherapy as first-line treatment for advanced gastric, gastroesophageal junction, and esophageal adenocarcinoma: 5-year follow-up results from CheckMate 649. Ann Oncol, 2026, S0923-7534.
22. Janjigian YY, Al-Batran SE, Wainberg ZA, et al. Perioperative durvalumab in gastric and gastroesophageal junction cancer. N Engl J Med, 2025, 393(3): 217-230.
23. Ding X, Chai J, Wang X, et al. Perioperative sintilimab plus oxaliplatin and S-1 (SOX) versus SOX alone in resectable locally advanced gastric cancer/gastroesophageal junction cancer (GC/GEJC): a multicenter randomized phase Ⅱ study (PERSIST). Ann Oncol, 2025,36: Suppl 2, S1113-S1114. doi: 10.1016/j.annonc.2025.08.2738.
24. Peng Z, Zhang X, Liang H, et al. Atezolizumab and trastuzumab plus chemotherapy for ERBB2-positive locally advanced resectable gastric cancer: a randomized clinical trial. JAMA Oncol, 2025, 11(6): 619-624.
25. Li B, Ma J, Zhao Q, et al. Cadonilimab (cado) plus oxaliplatin and tegafur-gimeracil-oteracil potassium (SOX) in resectable gastric and gastroesophageal junction (G/GEJ) adenocarcinoma: a phase Ⅱ study (Compassion-25). Ann Oncol, 2025, 36, suppl 4: S1858. doi: 10.1016/j.annonc.2025.10.128.
26. Yoshida K, Yamaguchi K, Okumura N, et al. Is conversion therapy possible in stage Ⅳ gastric cancer: the proposal of new biological categories of classification. Gastric Cancer, 2016, 19(2): 329-338.
27. Yoshida K, Yasufuku I, Terashima M, et al. International retrospective cohort study of conversion therapy for stage Ⅳ gastric cancer 1 (CONVO-GC-1). Ann Gastroenterol Surg, 2021, 6(2): 227-240.
28. 中國抗癌協會胃癌專業委員會, 中國醫師協會外科醫師分會上消化道外科醫師專家工作組, 中國老年保健協會消化系統疾病診療分會, 等. 胃癌肝轉移診斷與綜合治療中國專家共識(2026版). 中國實用外科雜志, 2026, 46(2): 153-161.
29. Yan C, Yang Z, Shi Z, et al. Intraperitoneal and intravenous paclitaxel plus S-1 versus intravenous paclitaxel plus S-1 in gastric cancer patients with peritoneal metastasis: results from the multicenter, randomized, phase 3 DRAGON-01 trial. J Clin Oncol, 2025, 43, suppl 4, 327. doi: 10.1200/JCO.2025.43.4_suppl.327.
30. Liu Y, Xue Q, Wang B, et al. Conversion therapy with sintilimab combined with chemotherapy and apatinib in stage Ⅳ gastric cancer. Int J Cancer, 2025, 157(8): 1637-1647.
31. 中國抗癌協會胃癌專業委員會. 中國抗癌協會胃癌專委會發展歷程回顧-砥礪奮進40載. 北京: 北京大學醫學出版社, 2022.
32. Allemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet, 2018, 391(10125): 1023-1075.
33. 梁寒. 中國胃癌外科30年發展實現跨越式國際領先. 中華胃腸外科雜志, 2025, 28(6): 688-692.
34. Chen Y, Jia K, Xie Y, et al. The current landscape of gastric cancer and gastroesophageal junction cancer diagnosis and treatment in China: a comprehensive nationwide cohort analysis. J Hematol Oncol, 2025, 18(1): 42. doi: 10.1186/s13045-025-01698-y.
35. 周慧君, 魏麗娟, 王偉平, 等. 基于單中心醫院腫瘤登記的2019年惡性腫瘤患者5年生存報告. 中國腫瘤臨床, 2026, 53(6): 1-8.

Previous Article
Progress in perioperative immunotherapy for locally advanced gastric cancer
Next Article
Research progress on molecular classification of gastric cancer

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

2025 Edition of CACA Integrated Guidelines for the Diagnosis and Treatment of Gastric Cancer—interpretation of the surgery and perioperative treatment section

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content