Dr. Yanghee Woo highlighted gaps in U.S. gastric cancer surgery, stressing R0 resection, D2 lymphadenectomy, high-volume care, and AI, ctDNA, and telesurgery to improve outcomes.

Dr. Raquel Yakoda emphasized standardized pathology, biomarker testing (HER2, PD-L1, MMR, CLDN18.2), proper specimen handling, and multidisciplinary collaboration to guide esophageal cancer care.

Debate highlighted perioperative FLOT plus durvalumab for adenocarcinoma, selective radiation for SCC or frail patients, and personalized treatment based on tumor biology and patient fitness.

Immunotherapy improves outcomes in select nonmetastatic upper GI cancers, with strongest benefit in PD-L1–positive and residual disease, while benefit in PD-L1–negative tumors remains uncertain.

Experts debated D3 dissection, emphasizing personalized gastric cancer care, FLOT use, digital pathology, occult metastases, and selective palliative radiation for bleeding or dysphagia.