Oligometastasis in Gastric Cancer Treatment: Is There a Place for the Surgeon?

Abstract

Metastatic gastric cancer traditionally hinders surgical treatment options, confining them to palliative procedures. The presence of metastases in these tumors is classified as M1, irrespective of their characteristics, quantity, or location. However, oligometastatic disease emerged as an intermediate state between localized and widely disseminated cancer. It exhibits diverse patterns based on metastatic disease extent, type, and location. Adequately addressing this distinctive metastatic state necessitates tailored strategies that surpass the realm of palliative care. Differentprimary tumor types present discernible scenarios of oligometastatic disease, including preferred sites of occurrence and chronological progression. Due to the novelty of this theme and the heterogeneity of the disease, uncertainties still exist, and the ability to provide confident guidelines is challenging. Currently, there are no effective predictors to determine the response and provide clear indications for surgical interventions and systemic treatments in oligometastatic disease. Treatment decisions are commonly based on apparent disease control by systemic therapies, with a short observation period and imaging assessments. Nonetheless, the inherent risk of misinterpretation remains a constant concern. The emergence of novel technologies and therapeutic modalities, such as immunotherapy, cellular therapy, and adoptive therapies, holds the potential to reshape the landscape of surgical treatment for the oligometastatic disease in gastric cancer, expanding the surgeon’s role in this multidisciplinary approach. Prospective tools for patient selection in oligometastatic gastric cancer are being explored. Using non-invasive, cost-effective, widely available imaging techniques that provide real-time information may revolutionize medical practice, ensuring precision medicine accessibility, even in resource-constrained small healthcare facilities. Incorporating molecular classifications, liquid biopsies, and radiomic analysis in a complementary protocol will augment patient selection precision for surgical intervention in oligometastasis. Hopefully, these advancements will render surgeries unnecessary in many cases by providing highly effective alternative treatments.

Are There Advantages in Double Transit Reconstruction After Total Gastrectomy in Patients With Gastric Cancer? A Systematic Review

“…By promoting better BMI and body weight levels, the DT reconstruction assists in maintaining body weight, as demonstrated by the evidence 3 . Such observation can be justified by preserving a physiological duodenal pathway, which favors the hormonal regulation and the mixing of bile and pancreatic juices with ingested food, optimizing absorption and microbiota control 37 .…”

“…The traditional curative treatment involves gastrectomy associated with lymphadenectomy due to the high incidence of lymph node involvement 3 , 8 , 24 . The dissection of lymph nodes at the D1/D1+ level, by removing only perigastric lymph nodes, is a less radical strategy used in the Japanese cases in this review.…”

“…Walter de Biase SILVA-NETO 1 , Claudemiro QUIRESE 1 , Eduardo Guimarães Horneaux de MOURA 2 , Fabricio Ferreira COELHO 3 , Paulo HERMAN 3 ABSTRACT -Background: The treatment of choice for patients with schistosomiasis with previous episode of varices is bleeding esophagogastric devascularization and splenectomy (EGDS) in association with postoperative endoscopic therapy. However, studies have shown varices recurrence especially after long-term follow-up.…”

Tumor Markers Expression Levels in Gastric Cancer Patient’s Peripheral Blood by Rt-PCR Assessment

“…There is great heterogeneity in the literature in terms of CTM analysis methodology, which hampers the comparison between this and other studies. It can be cited the differences related to sample types (lymph node or peripheral blood), handling of sample technique (total blood or neoplastic cellular enrichment methods), employed analysis type (immunohistochemistry or RT-PCR), the establishment of a cutoff value from which it can be considered positive for micrometastasis, and positive and negative control groups employment 3 . Thereby, each marker positivity percentage would not be approached, since this perspective does not suit the current study methodology.…”

The Molecular Cancer Subtypes Versus the Industry Arsenal. Which One Drives Gastric Cancer Treatment?

“…But even for this indication, if a tumor from other molecular subtypes presents a high expression of PD-1 (combined positive score [CPS]>1), this therapy will be made available for clinical use. Moreover, Epstein-Barr virus (EBV) subtypes and cancers with a high tumor mutation burden also represent potential indications for such therapy 3 , 4 .…”