Dai JJ, Cai JW, Xu XG, Tao GQ, Mao WJ. Shortening the hiatus: A preliminary challenge to the 4-6 weeks paradigm in adjuvant gastric cancer therapy. World J Gastrointest Oncol 2026; 18(9): 115778 [DOI: 10.4251/wjgo.115778]
Corresponding Author of This Article
Wen-Jun Mao, Department of Thoracic Surgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, No. 299 Qingyang Road, Wuxi 214023, Jiangsu Province, China. maowenjun1@njmu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
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editorial
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Dai JJ, Cai JW, Xu XG, Tao GQ, Mao WJ. Shortening the hiatus: A preliminary challenge to the 4-6 weeks paradigm in adjuvant gastric cancer therapy. World J Gastrointest Oncol 2026; 18(9): 115778 [DOI: 10.4251/wjgo.115778]
World J Gastrointest Oncol. Sep 15, 2026; 18(9): 115778 Published online Sep 15, 2026. doi: 10.4251/wjgo.115778
Shortening the hiatus: A preliminary challenge to the 4-6 weeks paradigm in adjuvant gastric cancer therapy
Jing-Jing Dai, Jun-Wen Cai, Xiao-Guang Xu, Guo-Quan Tao, Wen-Jun Mao
Jing-Jing Dai, Jun-Wen Cai, Department of Medical Laboratory, The Affiliated Huai’an No. 1 People’s Hospital of Nanjing Medical University, Huai’an 223300, Jiangsu Province, China
Xiao-Guang Xu, Research Center of High Altitude Medicine, People’s Hospital of Naqu Affiliated to Dalian Medical University, Naqu 852000, Xizang Autonomous Region, China
Guo-Quan Tao, Department of Gastrointestinal Surgery, The Affiliated Huai’an No. 1 People’s Hospital of Nanjing Medical University, Huai’an 223300, Jiangsu Province, China
Wen-Jun Mao, Department of Thoracic Surgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
Wen-Jun Mao, Wuxi College of Clinical Medicine, Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
Co-first authors: Jing-Jing Dai and Jun-Wen Cai.
Co-corresponding authors: Guo-Quan Tao and Wen-Jun Mao.
Author contributions: Dai JJ and Cai JW contributed equally as co-first authors; Dai JJ, Cai JW, and Mao WJ designed the format for writing the article; Dai JJ, Xu XG, Tao GQ, and Mao WJ revised the article; Tao GQ and Mao WJ contributed equally as co-corresponding authors; all authors approved the final version to publish.
Supported by Key Research and Development, and Transformation Project of Nagqu City, No. NQKJ-2025-07; National Natural Science Foundation of China, No. 81773538; Special Fund for the Construction of Key Medical Discipline Laboratories in Jiangsu Province, No. JSDW202233; and Jiangsu Province’s Sixth “333 Project” Talent Support Special Fund, No. S333YQ002.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Wen-Jun Mao, Department of Thoracic Surgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, No. 299 Qingyang Road, Wuxi 214023, Jiangsu Province, China. maowenjun1@njmu.edu.cn
Received: October 27, 2025 Revised: December 15, 2025 Accepted: January 22, 2026 Published online: September 15, 2026 Processing time: 304 Days and 22.2 Hours
Abstract
In this editorial we comment on the article by Lin et al published in the recent issue of the World Journal of Gastrointestinal Oncology. The conventional 4-6-week interval between gastrectomy and adjuvant chemotherapy (AC), a legacy of open surgery, persists despite advances in minimally invasive techniques and enhanced recovery protocols. Here we show that initiating AC on postoperative days 10-13 is feasible and does not increase surgical or hematologic toxicity. In a propensity-matched cohort of 219 stage II-III gastric cancer patients managed laparoscopically within an enhanced recovery after surgery framework, 21 patients received ultra-early AC. At three years, systemic relapse and overall survival were comparable to the standard-timing group. Although a downward trend in peritoneal metastasis rate was observed in the early chemotherapy group in the univariate analysis (4.8% vs 26%, P = 0.048), the difference was not significant after multivariate correction (hazard ratio = 0.42, 95% confidence interval: 0.09-1.89). This initial signal suggests that there may be potential benefits, but requires verification in larger-scale studies. Dose reductions were more frequent in the early-AC cohort (57% vs 28%), indicating physiological reserves are adequate but finite. These findings challenge the traditional postoperative timeline and suggest the immunosuppressive window (days 7-14) may offer a therapeutic opportunity for micrometastatic control. Our results support further investigation of ultra-early AC while underscoring the need to maintain dose density in future protocols.
Core Tip: This editorial is based on an innovative study that explored the initiation of ultra-early adjuvant chemotherapy in patients with stage II-III gastric cancer 10-13 days after laparoscopic gastrectomy. The research results indicate that the ultra-early protocol is safe and feasible compared with the traditional initiation, and shows a trend of potentially reducing the incidence of peritoneal metastasis (4.8% vs 26.2%). However, ultra-early chemotherapy is accompanied by a higher demand for dose adjustment, suggesting that future treatment strategies need to strike a balance between intervention timing and maintaining effective dose intensity, and should combine tumor characteristics to achieve individualized treatment.
