Surgical treatment of stage IV gastric cancer: is it worthwhile?

Abstract

Aim: To analyze clinical features and survival outcomes of patients with surgically-treated stage IV gastric cancer, in order to evaluate the suitability of surgery in these patients. Methods: We performed a systematic literature search using PubMed, MEDLINE, and Embase on October 9th, 2017. Survival outcomes data were collected. Results: The original search returned 2434 papers. Thirty-nine studies were included in the final review, of which 26 evaluated liver metastasis resection, four pulmonary metastasis resections and nine palliative gastrectomies. In total 933 patients underwent hepatectomy for liver metastasis from gastric cancer and median survival rates were 73%, 37% and 27% at 1-, 3-and 5-year respectively, with a median overall survival of 22 months (9-52 months). Data regarding resection of lung metastases were scarce and extremely heterogeneous. In total 1115 patients underwent palliative gastrectomy and median overall survival of patients was 12 months (8-53 months). In the only randomized controlled trial, no survival benefit of additional gastrectomy over chemotherapy alone was found, in contrast with the retrospective studies. Conclusion: Survival benefit of surgery in advanced gastric cancer is still unclear. Surgery may play an important role in highly selected patients. However, further randomized controlled trials are necessary to clarify the actual impact of surgery in these patients.

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

“…Peritoneal carcinomatosis (PC) continues to be a serious medical problem that increase the fatality of cancer. 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 ].…”

“…Gastroenteroanastomosis or jejunostomy are performed for helping patients to eat. As a rule, if the tumor is resectable, and there are life-threatening conditions (perforation, the threat of fatal bleeding from a disintegrating tumor, or decompensated stenosis), surgical treatment is performed according to vital indications [ 2 , 7 ]. There is an extremely high risk of complications and death after such kind of emergency surgeries, wherein the peritoneal disease also cannot be addressed [ 8 ].…”

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

“…Pergolini et al [13] performed a systematic review of literature on surgical resection for metastatic gastric cancer. Survival benefit of surgery in advanced gastric cancer is still unclear.…”