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

Yoshio Masuda^{1

2}, Kang Ler Fong¹, Danson Yeo³, Charleen Yeo³, Koy Min Chue⁴, Said Bani Araba⁵, Chiew Woon Lim⁶, Baldwin Yeung⁴, June Lee⁷, Jinlin Lin⁷, Claramae Chia^{8

9}, Matthew Ng⁶, Kennedy Ng⁶, Jens Samol^{10

11

12}, Daryl Chia⁵, Jun Liang Teh¹³, Raghav Sundar¹⁴, Wei-Peng Yong¹⁵, Hon Lyn Tan¹⁶, Kei Muro¹⁷, Florian Lordick¹⁸, Zev Wainburg¹⁹, Bo Chuan Tan²⁰, Guowei Kim²¹, Koichi Suda²², Simon Law²³, Takeshi Sano²⁴, Ramesh Gurunathan²⁵, Philip Chiu²⁶, Emile Woo²⁷, Cuong Duong²⁸, Han-Kwang Yang²⁹, Vo Duy Long³⁰, Hyung Ho Kim³¹, Han Alexander Mahendren³², Hyuk Joon Lee³³, Inian Samarasam³⁴, Takuji Gotoda³⁵, Reis Liew⁵, Asim Shabbir⁵, Myint Oo Aung³, Masanori Terashima³⁶, Edward Cheong³⁷, Jimmy So^{38

39

40}, Jeremy Tan¹

Affiliations

¹ Department of Upper Gastrointestinal & Bariatric Surgery, Division of Surgery, Singapore General Hospital, Singapore, Singapore.
² Ministry of Health Holdings, Singapore, Singapore.
³ Upper Gastrointestinal & Bariatric Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
⁴ Upper Gastrointestinal & Bariatric Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore.
⁵ Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital, Singapore, Singapore.
⁶ Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
⁷ Upper Gastrointestinal & Bariatric Surgery Service, Department of General Surgery, Changi General Hospital, Singapore, Singapore.
⁸ Division of Surgery and Surgical Oncology, Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), National Cancer Centre Singapore and Singapore General Hospital, Singapore, Singapore.
⁹ SingHealth Duke-NUS Surgery & Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
¹⁰ Department of Medical Oncology, Tan Tock Seng Hospital, Singapore, Singapore.
¹¹ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
¹² John Hopkins University School of Medicine, Baltimore, USA.
¹³ Upper Gastrointestinal & Bariatric Surgery Service, Department of General Surgery, Ng Teng Fong Hospital, Singapore, Singapore.
¹⁴ Center for Gastrointestinal Cancers, Yale Cancer Center, New Haven, United States of America.
¹⁵ Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.
¹⁶ OncoCare Cancer Centre, Singapore, Singapore.
¹⁷ Department of Clinical Oncology and Outpatient Treatment Centre, Alchi Cancer Centre Hospital, Nagoya, Japan.
¹⁸ Department of Medical Oncology, University Cancer Centre, Leipzig, Germany.
¹⁹ Department of Medicine, University of California Los Angeles Medical Centre, Los Angeles, CA, USA.
²⁰ Department of Upper Gastrointestinal Surgery, Clinic for Digestive Surgery, Singapore, Singapore.
²¹ Department of Upper Gastrointestinal Surgery, Crest Surgical Practice, Singapore, Singapore.
²² Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, Japan.
²³ Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Hong Kong, China.
²⁴ Gastroenterological Center, The Cancer Institute Hospital, Tokyo, Japan.
²⁵ Department of Surgery, Sunway Medical Centre, Subang, Selangor, Malaysia.
²⁶ 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.
²⁷ Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
²⁸ Department of Surgical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Vic., Australia.
²⁹ National Cancer Center, Goyang, Korea.
³⁰ Gastro-Intestinal Surgery Department, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
³¹ Comprehensive Cancer Center, Seoul National University Bundang Hospital, Seongnam, South Korea.
³² Hospital Sultanah Aminah, Johor Bahru, Malaysia.
³³ Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
³⁴ Upper Gastrointestinal Surgery Unit, Department of General Surgery Unit 3, Christian Medical College, Vellore, India.
³⁵ Department of Gastroenterology, Cancer Institute Hospital of JFCR, Tokyo, Japan.
³⁶ Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Monagakubo, Nagaizumi-Cho, Sunto-Gun, Nagaizumi, Shizuoka, Japan.
³⁷ Department of Upper Gastrointestinal Surgery, PanAsia Surgery, Singapore, Singapore.
³⁸ Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital, Singapore, Singapore. sursbyj@nus.edu.sg.
³⁹ Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore. sursbyj@nus.edu.sg.
⁴⁰ Division of Surgical Oncology, National University Cancer Institute of Singapore (NCIS), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore. sursbyj@nus.edu.sg.

PMID: 40514519
DOI: 10.1007/s00535-025-02266-4

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

Yoshio Masuda et al. J Gastroenterol. 2025 Sep.

. 2025 Sep;60(9):1079-1090.

doi: 10.1007/s00535-025-02266-4. Epub 2025 Jun 13.

Authors

Affiliations

¹ Department of Upper Gastrointestinal & Bariatric Surgery, Division of Surgery, Singapore General Hospital, Singapore, Singapore.
² Ministry of Health Holdings, Singapore, Singapore.
³ Upper Gastrointestinal & Bariatric Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
⁴ Upper Gastrointestinal & Bariatric Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore.
⁵ Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital, Singapore, Singapore.
⁶ Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
⁷ Upper Gastrointestinal & Bariatric Surgery Service, Department of General Surgery, Changi General Hospital, Singapore, Singapore.
⁸ Division of Surgery and Surgical Oncology, Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), National Cancer Centre Singapore and Singapore General Hospital, Singapore, Singapore.
⁹ SingHealth Duke-NUS Surgery & Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
¹⁰ Department of Medical Oncology, Tan Tock Seng Hospital, Singapore, Singapore.
¹¹ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
¹² John Hopkins University School of Medicine, Baltimore, USA.
¹³ Upper Gastrointestinal & Bariatric Surgery Service, Department of General Surgery, Ng Teng Fong Hospital, Singapore, Singapore.
¹⁴ Center for Gastrointestinal Cancers, Yale Cancer Center, New Haven, United States of America.
¹⁵ Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.
¹⁶ OncoCare Cancer Centre, Singapore, Singapore.
¹⁷ Department of Clinical Oncology and Outpatient Treatment Centre, Alchi Cancer Centre Hospital, Nagoya, Japan.
¹⁸ Department of Medical Oncology, University Cancer Centre, Leipzig, Germany.
¹⁹ Department of Medicine, University of California Los Angeles Medical Centre, Los Angeles, CA, USA.
²⁰ Department of Upper Gastrointestinal Surgery, Clinic for Digestive Surgery, Singapore, Singapore.
²¹ Department of Upper Gastrointestinal Surgery, Crest Surgical Practice, Singapore, Singapore.
²² Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, Japan.
²³ Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Hong Kong, China.
²⁴ Gastroenterological Center, The Cancer Institute Hospital, Tokyo, Japan.
²⁵ Department of Surgery, Sunway Medical Centre, Subang, Selangor, Malaysia.
²⁶ 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.
²⁷ Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
²⁸ Department of Surgical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Vic., Australia.
²⁹ National Cancer Center, Goyang, Korea.
³⁰ Gastro-Intestinal Surgery Department, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
³¹ Comprehensive Cancer Center, Seoul National University Bundang Hospital, Seongnam, South Korea.
³² Hospital Sultanah Aminah, Johor Bahru, Malaysia.
³³ Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
³⁴ Upper Gastrointestinal Surgery Unit, Department of General Surgery Unit 3, Christian Medical College, Vellore, India.
³⁵ Department of Gastroenterology, Cancer Institute Hospital of JFCR, Tokyo, Japan.
³⁶ Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Monagakubo, Nagaizumi-Cho, Sunto-Gun, Nagaizumi, Shizuoka, Japan.
³⁷ Department of Upper Gastrointestinal Surgery, PanAsia Surgery, Singapore, Singapore.
³⁸ Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital, Singapore, Singapore. sursbyj@nus.edu.sg.
³⁹ Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore. sursbyj@nus.edu.sg.
⁴⁰ Division of Surgical Oncology, National University Cancer Institute of Singapore (NCIS), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore. sursbyj@nus.edu.sg.

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.

Keywords: Chemotherapy; Gastrectomy; Gastric cancer surgery; Immunotherapy; Locally advanced gastric adenocarcinoma; Modified Delphi consensus.

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Conflict of interest statement

Declarations. Conflict of interest: None to declare. Ethical approval: This article does not contain any studies with human or animal subjects performed by any of the authors. the undersigned authors warrant that the article is original, is not under consideration by another journal, and has not been published previously.

References

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical