Objective: The aim of this study is to analyze comprehensively the capability of surgery and chemotherapy (neoadjuvant and adjuvant) in improving treatment outcomes in patients with non-antral gastric carcinoma.

Material and methods: The study enrolled the patients with non-antral gastric carcinoma undergone radical-intent surgery (349 patients) in Oncologic Clinic, Azerbaijan Medical University from January 2008 till October 2022. All patients underwent D2 lymph node dissection. Neoadjuvant chemotherapy was conducted in 28 patients (with advanced locoregional disease based on CT), adjuvant chemotherapy in 306 patients. 

Results:  Neoadjuvant chemotherapy was able to transform locally advanced (unresectable based on CT) gastric carcinoma into resectable disease in 82.4% (28/34) of the cases. Extended total gastrectomy via laparotomy (with diaphragmotomy) for Siewert II esophagogastric junction adenocarcinoma provided 97.2% (175/180) R0 resection. >80% distal subtotal gastrectomy for middle-third gastric carcinoma performed in selected patients provided 100% R0 resection. 

Conclusions: Neoadjuvant chemotherapy with novel chemotherapeutic regimens is able to provide a high resectability rate in patients with advanced locoregional non-antral gastric carcinoma assessed unresectable based on CT at diagnosis. Extended total gastrectomy via laparotomy for Siewert II esophagogastric junction adenocarcinoma with a proximal resection margin of an average of 3.0 cm (2.6-4.4 cm) is one of the optimal surgical options and can be more tolerable surgery compared to other surgical procedures (e.g., total gastrectomy via thoracolaparotomy, esophagogastrectomy). Extended lymph node dissection should include all relevant lymph node stations: removing the relevant lymph nodes may be a stronger prognostic factor than the number of lymph nodes removed. In regions with a higher proportion of early gastric carcinoma the survival of patients with T2-T4a gastric carcinoma is expected to be higher compared to the regions with a lower proportion of that. Adjuvant chemotherapy is expected to be more effective in regions with a lower proportion of early gastric carcinoma.