Reconsideration of the controversy of surgery after neoadjuvant therapy for esophagogastric junction cancer in the immunotherapy era

In the era of immunotherapy, the perioperative treatment of locally advanced esophagogastric junction cancer has gradually changed from traditional two‑drug or three‑drug chemotherapy to immunotherapy combined with chemotherapy. The clinical trials carried out at present have achieved positive results in pathological response, downstaging and long‑term survival. However, whether it is possible to challenge the traditional radical principle of gastrectomy for gastric cancer in primary lesion resection and regional lymph node dissection, to preserve organ function and reduce surgical trauma is more controversial. Appropriate patients are selected by preoperative precise molecular diagnosis. After neoadjuvant immunotherapy combined with chemotherapy, the surgical approach is optimized, and the primary lesion is resected and the metastatic lymph node dissection or regional lymph node dissection is performed, to preserve more no metastatic lymph nodes to maintain the activity of T cells and the specific killing function against tumor cells. Long-term survival benefits and improved quality of life will ultimately be achieved.Based on the latest clinical and basic research findings, the authors elaborate on the relevant hotspots and controversies of perioperative immunotherapy combined with chemotherapy for esophagogastric junction cancer, aiming to better guide clinical practice in the future.