Role of Enteral Nutrition in Neoadjuvant Therapy for Locally Advanced Gastric Cancer with Pyloric Obstruction: A Case Series

Abstract

Objective: To evaluate whether neoadjuvant therapy can be carried out in pyloric obstruction secondary to gastric cancer through nasojejunal enteral nutrition and assess tumor regression and improvement in surgical outcomes.Material and Methods: A retrospective cohort analysis of patients diagnosed with locally advanced gastric cancer (LAGC) with pyloric obstruction who received preoperative nutritional support via nasojejunal tube feeding. Once nutritional adequacy was achieved, patients proceeded to neoadjuvant therapy consisting of S-1 plus oxaliplatin (SOX chemotherapy), targeted therapy with apatinib, and immunotherapy with sintilimab. Tumor and lymph node responses were assessed radiologically and confirmed by postoperative pathological analysis.Results: Enteral feeding was well tolerated without major complications, and all patients were able to complete the neoadjuvant regimen. Imaging showed dramatic shrinkage of the tumor mass and regression of regional lymph node enlargement. After surgery, certain cases yielded a result of complete tumor regression (Tumor Regression Grade 0) in the pathology, including resolution of lymph node metastases. Clinical results established that nutritional optimization helped in the effective downstaging of tumors and thus improved the chances of R0 resection.Conclusion: Nasoenteric enteral nutrition is a feasible and effective method to enable the safe delivery of neoadjuvant therapy in patients with pyloric obstruction resulting from gastric cancer. It optimizes nutrition, enhances treatment tolerance, and contributes to favorable oncologic outcomes.