Updates in the Multidisciplinary Approach for Resectable Gastroesophageal Adenocarcinoma and Peritoneal-Limited Disease

The management of gastroesophageal adenocarcinoma requires a nuanced, multidisciplinary approach. For resectable disease, perioperative FLOT is the newly preferred standard based on results from the ESOPEC trial, but careful patient selection and consideration of alternatives such as chemoradiotherapy remain crucial. Immunotherapy is transforming the treatment of mismatch repair–deficient tumors. For peritoneal-limited disease, systemic therapy remains the foundation of treatment. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is now included in the NCCN Guidelines for Esophageal and Esophagogastric Junction Cancers as an option for highly selected patients treated at experienced centers who are capable of achieving complete cytoreduction following a good response to chemotherapy. Bidirectional intraperitoneal therapy is a promising investigational approach currently under active study. Ongoing trials continue to refine patient selection and treatment strategies across these complex clinical scenarios.