Reassessment Strategies and Realistic Expectations for Completing Perioperative FLOT

This segment focuses on how clinicians reassess locally advanced gastric tumors following neoadjuvant therapy, identify candidates for safe surgery, and manage nutritional and treatment-tolerance challenges. The panel discusses the importance of repeat staging for high-risk presentations, noting that patients with bulky T4A N2 disease often undergo a second PET scan, repeat endoscopy, and repeat diagnostic laparoscopy to confirm stability or regression before proceeding to resection. The conversation then expands to feeding access decisions. For distal gastric cancers, the panel highlights that stents can compromise curative surgery, while internal gastrojejunostomy bypass can preserve oral intake and avoid the discomfort associated with jejunostomy tubes. Attention then shifts to realistic expectations for completing all eight perioperative FLOT cycles. The group emphasizes that full-dose delivery is uncommon due to neuropathy, cytopenias, and cumulative toxicity, making dose reductions or regimen modifications routine. The segment closes with discussion of nutrition counseling, structured follow-up with dietitians, weight-maintenance expectations, and the role of feeding tubes and appetite stimulants in keeping patients surgical candidates.