Conversion Surgery for Stage IV Gastric Cancer

Zhang, Fei; Huang, Xuan; Song, Yongxi; Gao, Peng; Zhou, Cen; Guo, Zhexu; Shi, Jinxin; Wu, Zhonghua; Wang, Zhenning

doi:10.3389/fonc.2019.01158

Cited by 30 publications

(35 citation statements)

References 85 publications

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“…In their opinion, this could guide conversion surgery in patients benefiting from chemotherapy. Historically, two main subsets of patients have been defined: those with locally advanced unresectable disease (mainly due to primary tumor extension and/or abdominal nodal involvement) and those with distant metastatic disease [ 169 ]. Although often combined and treated as a single entity, the prognosis differs, and different approaches can be considered in these two groups.…”

Section: Resultsmentioning

confidence: 99%

Beyond the Guidelines: The Grey Zones of the Management of Gastric Cancer. Consensus Statements from the Gastric Cancer Italian Network (GAIN)

Fornaro

Spallanzani

Vita

et al. 2021

Cancers

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Background: Management of gastric and gastroesophageal junction (GEJ) adenocarcinoma remains challenging, because of the heterogeneity in tumor biology within the upper gastrointestinal tract. Daily clinical practice is full of grey areas regarding the complexity of diagnostic, staging, and therapeutic procedures. The aim of this paper is to provide a guide for clinicians facing challenging situations in routine practice, taking a multidisciplinary consensus approach based on available literature. Methods: The GAIN (GAstric cancer Italian Network) group was established with the aims of reviewing literature evidence, discussing key issues in prevention, diagnosis, and management of gastric and GEJ adenocarcinoma, and offering a summary of statements. A Delphi consensus method was used to obtain opinions from the expert panel of specialists. Results: Forty-nine clinical questions were identified in six areas of interest: role of multidisciplinary team; risk factors; diagnosis; management of early gastric cancer and multimodal approach to localized gastric cancer; treatment of elderly patients with locally advanced resectable disease; and treatment of locally advanced and metastatic cancer. Conclusions: The statements presented may guide clinicians in practical management of this disease.

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Section: Resultsmentioning

confidence: 99%

Beyond the Guidelines: The Grey Zones of the Management of Gastric Cancer. Consensus Statements from the Gastric Cancer Italian Network (GAIN)

Fornaro

Spallanzani

Vita

et al. 2021

Cancers

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“…Conversion surgery therapies, including liver resection, RFA, or microwave coagulation therapy (MCT) combined with systemic chemotherapy, have been reported for unresectable advanced gastric cancer patients with LMs. 13 However, the clinical significance of conversion surgery remains controversial for late-stage colorectal cancer patients. Herein, we described a high-risk stage-IV rectal carcinoma patient who was initially unresectable according to the NCCN guidelines, with a high CRS score of 4, but received conversion surgery combined with systemic chemotherapy and achieved a favorable long-term clinical outcome (pCR) of approximately 28 months.…”

Section: Discussionmentioning

confidence: 99%

Clearance of circulating tumor DNA in a high-risk stage-IV rectal carcinoma patient with synchronous liver metastases after conversion surgery is correlated with pathologic complete response

Huang

Jia

Wang

et al. 2021

Clin Med Insights Gastroenterol

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Colorectal cancer is the third most common cancer worldwide, and its incidence continues to grow. Approximately one-third of patients with colorectal cancer develop liver metastases during the natural course of disease. Complete surgical resection is associated with very low mortality in colorectal liver metastasis patients, but only a small fraction of colorectal liver metastasis patients fulfill the selection criteria for surgical treatment. We herein describe a high-risk stage-IV rectal carcinoma patient who was initially unresectable according to the National Comprehensive Cancer Network guidelines with a clinical risk score of 4 but received conversion surgery combined with systemic chemotherapy and achieved a favorable long-term clinical outcome (pathologic complete response) of approximately 28 months. Furthermore, serial circulating tumor DNA monitoring using next-generation sequencing provided a comprehensive view of the patient’s clinical and pathologic status for better clinical decision support over the course of the disease. The absence of circulating tumor DNA/cells after conversion surgery was correlated with pathologic complete response. This case study not only demonstrated that a curative oncosurgical approach could be considered for high-risk colorectal liver metastasis patients under specific circumstances but also highlighted the role of circulating tumor DNA monitoring to gain further insight into the evolution of a patient’s response over time.

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“…At present, the primary treatment for stage IV GC is systematic. Surgeries are often performed in emergencies such as bleeding, perforation, or obstruction 12 . Moreover, the surgery of the primary tumor can also reduce the tumor burden, reverse the tumor-induced immunosuppression, and eliminate the source of further metastasis 13 .…”

Section: Discussionmentioning

confidence: 99%

Identifying Benefit Factors Associated With Primary Tumor Resection in Patients With Stage IV Gastric Cancer: a Propensity Score-matched Analysis

Yan

Liu

2021

Preprint

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Background: At present, the beneficial factors related to surgery at the primary tumor site in patients with stage IV gastric cancer (GC) are unclear. We developed a new selection process to determine the beneficial factors associated with primary tumor surgery.Methods: Patients with stage IV GC were screened from the Surveillance, Epidemiology, and End Results (SEER) database and were divided into surgery and non-surgery groups. The Kaplan-Meier method was used to estimate the survival curve before and after the propensity score-matched analysis (PSM). We believe that patients in the surgery group who have a longer median cancer-specific survival (CSS) time than those in the non-surgery group can benefit from surgery. Use Multivariate Logistic regression analysis to determine the benefit factors related to surgery.Results: A total of 7259 patients with stage IV GC were included, of which 29.95% (2174) underwent primary tumor surgery. After PSM, the median CSS of the surgery group and the non-surgery group was 12 months and 7 months, respectively (p < 0.001). Multivariate COX regression analysis showed that age, T stage, primary tumor site, histological classification, histological grade, and chemotherapy were independently correlated with CSS. We included the independent related factors affecting CSS in COX analysis in the multivariate Logistics regression model. The results showed that T stage, histological grade, and chemotherapy were related to surgical benefit.Conclusion: The surgery to the primary tumor site can prolong the survival time of patients with stage IV GC, and surgeons should screen patients before surgery. Our results show that patients with T stage T4b and histological grade GIII/GIV do not benefit from surgery, while patients receiving chemotherapy can benefit from surgery.

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Conversion Surgery for Stage IV Gastric Cancer

Cited by 30 publications

References 85 publications

Beyond the Guidelines: The Grey Zones of the Management of Gastric Cancer. Consensus Statements from the Gastric Cancer Italian Network (GAIN)

Beyond the Guidelines: The Grey Zones of the Management of Gastric Cancer. Consensus Statements from the Gastric Cancer Italian Network (GAIN)

Clearance of circulating tumor DNA in a high-risk stage-IV rectal carcinoma patient with synchronous liver metastases after conversion surgery is correlated with pathologic complete response

Identifying Benefit Factors Associated With Primary Tumor Resection in Patients With Stage IV Gastric Cancer: a Propensity Score-matched Analysis

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