245 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 S. H. Noh, W. J. Hyung (eds.), Surgery for Gastric Cancer, https://doi.org/10.1007/978-3-662-45583-8_21 Surgery After Neoadjuvant Chemotherapy Daniel Reim, Alexander Novotny, and Christoph Schuhmacher Introduction Neoadjuvant/perioperative chemotherapy (CT) for locally advanced gastric cancer has become a routine clinical procedure on the base of recent randomized controlled trials. This chapter describes the European prospective randomized controlled trials and focuses on their surgical results. Outcome-related measures are described from a surgical point of view. Numerous aspects are discussed, and the infuence of surgical out- comes on oncologic results is critically reviewed. Clinical Trials for Neoadjuvant Chemotherapy and Their Surgical Outcomes Neoadjuvant or perioperative CT is an accepted and recommended therapeutic approach of GC treatment in most European countries [1]. This goes back to the results of the British MAGIC [2] and the French FNLCC/FFCD trial [3], both of which included a rather large number of patients and were, thus, adequately powered. Both trials directly compared surgery with or without neo- adjuvant or perioperative CT and showed a sig- nifcant beneft for the multimodal approach. Different theoretical advantages of neoadju- vant therapy over adjuvant therapy are discussed for potentially resectable GC [4]. One is the usu- ally better general health condition of patients in the neoadjuvant setting. Another advantage is that downstaging of the tumor may lead to higher R0 resection rates. Several other benefts like effects on occult metastasis or single tumor cell dissemination (micrometastasis) at the earliest point in time are also discussed. The MAGIC trial is the presently most recog- nized landmark study for perioperative CT [2]. Between 1994 and 2002 centers in the UK, Europe and Asia recruited patients with resect- able GC and adenocarcinomas of the esophago- gastric junction (EGJ). Patients were randomized to surgery with perioperative CT (n = 250) or sur- gery only (n = 253). CT consisted of three D. Reim (*) · A. Novotny · C. Schuhmacher (*) Klinik und Poliklinik für Chirurgie, TUM School of Medicine, Munich, Germany e-mail: Daniel.reim@tum.de; christoph.schuhmacher@ecrin.org 21 Statement: This review fully has not been published or submitted before. All authors declare that they partici- pated in the literature review and that they have seen and approved the fnal version. None of the authors have any conficts of interest. No funds or grants or company gifts have been received, nor has the article been written by a third party.