Conversion surgery for stage IV gastric cancer

Abstract

Gastric cancer with distant metastases, such as para-aortic lymph node metastases, hepatic metastases, and peritoneal dissemination, is classified as stage IV. In this situation, cancer cells have formed micrometastases throughout the body; therefore, according to the algorithm of the Japanese guidelines, stage IV cancer is outside the indication for curative resection. Recent advances in some chemical agents have been remarkable, and some patients have survived for long periods even with stage IV gastric cancer. Thus, even in patients with stage IV gastric cancer, there is a possibility that gastrectomy as conversion surgery could play an important role in the treatment strategy. Gastrectomy as conversion therapy can be safely conducted without perioperative mortality and is considered a sufficiently acceptable treatment strategy. However, the significance of conversion surgery for stage IV gastric cancer remains controversial. In this review, we summarize the treatment strategies and outcomes of conversion surgery for stage IV gastric cancer.

Combined modality treatment of patients with stage IV gastric cancer with peritoneal carcinomatosis

“…Сроки наблюдения за больными составили от 10 до 37,9 мес. В основной группе медиана ВБП составила 15,8 мес, с интерквартильным размахом (13,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)1), в группе контроля -11,2 (10,(3)(4)(5)(6)(7)(8)(9)(10)(11)6) мес (р<0,001; χ 2 =47,662). Медиана ОВ в основной группе составила 18,7 мес, с интерквартильным размахом (15,0-24,3), в контрольной группе -12,7 (11.3-13.1) мес (р<0,001; χ 2 =50,731).…”

“…Перитонеальный канцероматоз (ПК) -крайне неблагоприятный вариант прогрессирования рака желудка (РЖ) [1,2]. По данным литературы, РЖ IV стадии выявляется у 39,8 % первичных пациентов, при этом диссеминация по брюшине встречается у 14-43 % пациентов [3,4]. Локальная диссеминация по брюшине без других отдаленных метастазов встречается в 18-20 % случаев от общей доли РЖ IV стадии [5,6].…”

Gene Expression Profile-Guided Personalized Intraperitoneal Chemotherapy for Gastric Cancer Peritoneal Carcinomatosis

“…PC is one of the most unfavorable sites of progression for malignant tumors of various localizations, especially gastric cancer (GC) [ 1 , 2 ]. According to the literature, synchronous PC occurs in 14% of patients in primary GC, and in 43% of patients it occurs during treatment [ 3 , 4 ].…”

Introduction to the special issue on reviews of gastric cancer metastasis and treatment

“…Recent advances in chemotherapy enabled conversion surgery for patients with initially unresectable gastric cancer. Ida and Watanabe [14] reviewed the treatment strategies for stage IV gastric cancer and discussed the potential efficacy of conversion surgery. Pancreaticoduodenectomy (PD) is the only possible treatment for achieving R0 resection when a tumor and/ or lymph node metastasis directly invades the pancreatic head or infiltrates the duodenum.…”