Oncogastroenterology, da Vinci robotic surgery, HIPEC, targeted therapy and immunotherapy
Stomach cancer is one of the most complex oncological diseases, where the treatment outcome directly depends on the accuracy of staging and the coordinated work of the surgeon, oncologist, and pathomorphologist. At the Ichilov (Sourasky) Medical Center in Tel Aviv, patients undergo the entire process within one clinic: from the initial gastroscopy with targeted biopsy and endoscopic ultrasound (EUS) to assess the depth of invasion — to PET-CT, determining the molecular profile of the tumor (HER2, MSI, PD-L1, Claudin 18.2), and selecting a personalized treatment plan at the Tumor Board.
The surgical stage at Ichilov is led by highly qualified oncogastroenterologists and surgeons. Depending on the location and depth of invasion, endoscopic resections of the mucosa and submucosa (EMR/ESD) are performed for early cancer, laparoscopic or robot-assisted (da Vinci) subtotal resection, and gastrectomy with D2 lymphadenectomy. In cases of peritoneal carcinomatosis, cytoreductive surgery with intraoperative hyperthermic chemotherapy (HIPEC) is applied, significantly improving the prognosis for certain patient categories.
Pharmacological treatment is based on international NCCN and ESMO protocols: perioperative chemotherapy according to the FLOT regimen, targeted therapy (trastuzumab for HER2-positive tumors), immunotherapy with PD-1 inhibitors — nivolumab, pembrolizumab — for MSI-high and high PD-L1 expression, as well as new drugs against Claudin 18.2. Patients with advanced disease have access to clinical trials at the Tel Aviv Sourasky Medical Center.
Below are materials from the subsection: detailed reviews of the treatment of adenocarcinoma and gastric lymphoma, articles on diagnostics (gastroscopy, complete gastric examination), as well as on precursor background conditions — polyps, erosions, and peptic ulcer disease. A separate section features specialized doctors at Ichilov, specializing in gastrointestinal oncology, and the "second opinion" program with a review of histology in the clinic's pathomorphological laboratory.