Neoadjuvant therapy now hinges on the FLOT regimen for resectable gastroesophageal junction adenocarcinoma, significantly impacting surgical outcomes.

• The FLOT regimen shows improved overall survival and pathologic complete response rates compared to ECF.
• Neoadjuvant chemoradiotherapy boosts local control but has limited effect on distant recurrence.

Surgeons should prioritize FLOT to enhance patient outcomes and consider immunotherapy integration for future advancements.

• Recent studies confirm FLOT’s superiority over older regimens, refining patient selection strategies.