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We conducted this study to evaluate the efficacy of preoperative chemotherapy using a modified regimen of docetaxel, cisplatin, and S-1 (DCS) for GC with bulky LNs, assessing feasibility, toxicity, response rate, and oncological outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Thirty-two patients who had GC with bulky LNs diagnosed between Jan, 2018 and Oct, 2022 received three or four cycles of modified DCS regimen preoperatively. The primary outcome was 3\u00a0year overall survival (OS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The completion rate of preoperative chemotherapy was 90.6% (4 cycles: 50.0%, 3 cycles: 40.6%). The disease control rate (DCR) and clinical response rate (RR) were 87.5% and 81.3%, respectively. Grade-3\/4 neutropenia and anemia developed in 6.2% and 9.4%, respectively. Twenty-two patients with partial response (PR) agreed to undergo gastrectomy and LN dissection. Pathologic complete response (CR) was achieved in 15.6%. After surgery, there were no grade\u2009&gt;\u2009\u2009=\u20093 postoperative complications. The R0-resection rate was 65.6%. The 3\u00a0year OS and progression-free survival (PFS) rates were 43.0% and 37%, respectively, for all eligible patients. The 3\u00a0year OS and PFS of patients in the surgery group with negative para-aortic LNs were 58% and 47.0%, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Preoperative chemotherapy with a modified DCS regimen demonstrated high tolerance, a clinical response rate, and satisfactory 3\u00a0year survival outcomes. Thus, a preoperative modified DCS regimen with 3\u20134 cycles is a promising approach for GC with bulky LNs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00595-025-03114-x","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T15:32:52Z","timestamp":1756135972000},"page":"195-206","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative chemotherapy with a modified docetaxel, cisplatin, and S-1 regimen, followed by gastrectomy and lymphadenectomy for gastric cancer with bulky lymph nodes"],"prefix":"10.1007","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7088-5532","authenticated-orcid":false,"given":"Vo Duy","family":"Long","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dang Quang","family":"Thong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tran Quang","family":"Dat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doan Thuy","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tran Vinh","family":"Tho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tran Duy","family":"Phuoc","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nguyen Viet","family":"Hai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nguyen Lam","family":"Vuong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lam Quoc","family":"Trung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nguyen Hoang","family":"Bac","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,8,25]]},"reference":[{"issue":"6","key":"3114_CR1","doi-asserted-by":"publisher","first-page":"291","DOI":"10.5306\/wjco.v6.i6.291","volume":"6","author":"S Ito","year":"2015","unstructured":"Ito S, Ito Y, Misawa K, Shimizu Y, Kinoshita T. 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Vo Duy Long, Dang Quang Thong, Tran Quang Dat, Doan Thuy Nguyen, Tran Vinh Tho, Tran Duy Phuoc, Nguyen Viet Hai, Nguyen Lam Vuong, Lam Quoc Trung,  and Nguyen Hoang Bac disclose no potential or actual personal, political or financial conflict of interest in the material, information, or techniques described in the paper.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study was conducted according to the guidelines of the Declaration of Helsinki and approved by Institutional Review Board, University Medical Center Ho Chi Minh city. Approval to perform research on human subjects in this study was provided by the Institutional Review Board, University Medical Center Ho Chi Minh city (registration number: 37\/HDDD-DHYD).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}