LAUSR

Dear Editor, We appreciate with interest the paper written by Bracale et al. entitled “Impact of neoadjuvant therapy followed by laparoscopic radical gastrectomy with D2 lymph node dissection in Western population: a multi‐institutional propensity score matched study”. Although indications to neoadjuvant chemotherapy (NAC) for locally advanced gastric cancer (lAGC) are still debated, nowadays their importance has been increasingly recognized. To date, the major international gastric cancer guidelines recommend NACT for lAGC becoming thus a standardized clinical practice. As a matter of fact, both in the West and in the East, NAC is widely used and accepted based on a lot of clinical randomized trials that demonstrated its safety and survival benefit. For this reason, we strongly think that we should not discuss anymore NAC in terms of survival outcomes because it is clearly demonstrated and must be widely adopted. Analyzing survival outcomes, we would suggest stratifying patients according to Lauren histotype (intestinal vs diffuse type), location (stomach cancer vs. cardias one), and different chemotherapic schemes before asserting that NAC is associated with poor survival outcomes. Talking about postoperative complications after NAC, Liao et al. has recently published a meta‐analytic work in which is demonstrated that laparoscopic gastrectomy (LG) is an effective and feasible procedure for the treatment of AGC patients treated with NAC, and LG patients have much less postoperative than open gastrectomy patients. Also, Hu et al. in their published meta‐analysis concluded that NAC must be considered safe and feasible for improved R0 resection rate as well as decreased reoperations and anastomotic leakages. We believe that fibrosis and edema of cancer foci after NAC harm surgical safety and efficacy. NAC causes an inflammatory tissue that added to the difficulty of hemostasis, performed by LS, which could increase the difficulty in performing an adequate D2 lymphadenectomy. We conclude that the safety and efficacy of NAC for GC have been widely proven, though many problems need to be solved. Luigina Graziosi Elisabetta Marino Annibale Donini