Conversion surgery for gastric cancer: A cohort study from a western center

Morgagni, Paolo; Solaini, Leonardo; Framarini, Massimo; Vittimberga, Giovanni; Gardini, Andrea Casadei; Tringali, Domenico; Valgiusti, Martina; Monti, Manlio; Ercolani, Giorgio

doi:10.1016/j.ijsu.2018.04.016

Cited by 53 publications

(60 citation statements)

References 24 publications

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“…Patients who underwent R0 resection had an MST of 41.3 mo[ 84 ]. Recently, Morgagni et al[ 85 ] reported a Western series of 22 patients among 73 unresectable subjects who underwent R0 resection after induction chemotherapy. Gastrectomy plus HIPEC was performed in 9 patients.…”

Section: From Salvage Surgery To Conversion Therapymentioning

confidence: 99%

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Conversion surgery for gastric cancer patients: A review

Zurleni¹,

Gjoni²,

Altomare³

et al. 2018

WJGO

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Gastric cancer (GC) is the third most common cancer-related cause of death worldwide. In locally advanced tumors, neoadjuvant chemotherapy has recently been introduced in most international Western guidelines. For metastatic and unresectable disease, there is still debate regarding correct management and the role of surgery. The standard approach for stage IV GC is palliative chemotherapy. Over the last decade, an increasing number of M1 patients who responded to palliative regimens of induction chemotherapy have been subsequently undergone surgery with curative intent. The objective of the present review is to analyze the literature regarding this approach, known as “conversion surgery”, which has become one of the most commonly adopted therapeutic options. It is defined as a treatment aiming at an R0 resection after chemotherapy in initially unresectable tumors. The 13 retrospective studies analyzed, with a total of 411 patients treated with conversion therapy, clearly show that even if standardization of unresectable and metastatic criteria, post-chemotherapy resectability evaluation and timing of surgery has not yet been established, an R0 surgery after induction chemotherapy with partial or complete response seems to offer superior survival results than chemotherapy alone. Additional larger sample-size randomized control trials are needed to identify subgroups of well-stratified patients who could benefit from this multimodal approach.

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Section: From Salvage Surgery To Conversion Therapymentioning

confidence: 99%

“…Gastrectomy plus HIPEC was performed in 9 patients. The 1- and 3-year survival rates were 63.6% and 39.4%, respectively[ 85 ].…”

Section: From Salvage Surgery To Conversion Therapymentioning

confidence: 99%

Conversion surgery for gastric cancer patients: A review

Zurleni¹,

Gjoni²,

Altomare³

et al. 2018

WJGO

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“…According to the ToGA trial, the median OS was observed to extend to 13.8 months following trastuzumab therapy [2]. On the other hand, recent studies have shown the prognostic benefit of conversion surgery after chemotherapy in patients with unresectable gastric cancer [12][13][14][15][16][17][18][19]. Especially, some reports suggested prognostic importance of R0 resection after palliative chemotherapy in conversion surgery of stage IV gastric cancer patients who responded to the chemotherapy [15][16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Prognostic benefit of conversion surgery for HER2 positive stage IV gastric cancer; a case series study of eleven patients treated with trastuzumab-based chemotherapy

et al. 2020

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Background Since the ToGA trial, trastuzumab-based chemotherapy is the standard treatment for HER2 positive stage IV gastric cancer. However, it is not yet clear whether surgical resection after trastuzumab-based chemotherapy (conversion surgery) can improve survival of HER2 positive stage IV gastric cancer. The purpose of this study is to evaluate the prognostic benefit of conversion surgery in HER2 positive stage IV gastric cancer patients. Case presentation We retrospectively investigated the medical records of the patients with HER2 positive (IHC3(+) or IHC2(+)/FISH(+)) stage IV gastric cancer treated with trastuzumab-based chemotherapy as the first line treatment. Overall survival (OS) was compared between patients with conversion surgery and without. Eleven HER2 positive stage IV gastric cancer patients treated with trastuzumab-based chemotherapy as the first line treatment were evaluated. Response rate was 63.6%, and 6 of 11 patients could receive conversion surgery. R0 resection was achieved in four patients. In Kaplan–Meier analysis, patients who received conversion surgery showed significantly better OS than those without surgery (3-year survival rate, 66.7% vs. 20%, P = 0.03). The median OS of patients who achieved R0 resection is 51.8 months. Conclusions Conversion surgery might have a survival benefit for HER2 positive stage IV gastric cancer patients. If curative surgery is technically possible, conversion surgery could be a treatment option for HER2 positive stage IV gastric cancer.

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“…The prognosis for those undergoing systemic therapies only for gastric cancers who were either initially diagnosed as metastatic or having developed recurrence after initial curative resection was dismal, in spite of recent advancements made in targeted and immune-based therapies [3]. Accordingly, there have been attempts to proceed to conversion surgery in metastatic gastric cancer in an effort to add survival benefit to chemotherapy even when systemic treatment only could at least temporarily control the microscopic disease [4][5][6][7][8][9][10][11][12].…”

Section: Discussionmentioning

confidence: 99%

“…Conversion surgery is a term for operative resection of primary or metastatic lesions with a curative intent, after confirming either a complete response (CR) or partial response (PR), following several cycles of palliative chemotherapy. Although addition of gastrectomy (without metastasectomy) to palliative chemotherapy in metastatic gastric cancer did not show survival benefit when compared with chemotherapy only in the previous REGATTA trial [4], there have been recent attempts to conduct surgery in selected patients with a good initial response to palliative chemotherapy [5][6][7][8][9][10][11][12]. It has been shown to improve the prognosis in a few retrospective studies.…”

Section: Introductionmentioning

confidence: 99%

Conversion Surgery in Metastatic Gastric Cancer and Cancer Dormancy as a Prognostic Biomarker

Choe

Kim

Han

et al. 2019

Cancers

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The role of conversion surgery in metastatic gastric cancer remains unclear. Cancer dormancy markers might have a role in predicting the survival in patients with conversion surgery. We identified 26 patients who went through conversion surgery, i.e., a curative-intent gastrectomy with metastasectomy after chemotherapy in initially metastatic gastric cancer. As controls, 114 potential candidates for conversion surgery who only received chemotherapy were included for the propensity score matching. Conversion surgery showed a significantly longer overall survival (OS) compared with only palliative chemotherapy (median-43.6 vs. 14.0 months, respectively, p < 0.001). This better survival in the conversion surgery group persisted even after propensity matching (p < 0.001), and also when compared to patients with tumor response over 5.1 months in the chemotherapy only group (p = 0.005). In the conversion surgery group, OS was longer in patients with R0 resection (22/26, 84.6%) than without R0 resection (4/26, 15.4%) (median-not reached vs 22.1 months, respectively, p = 0.005). Although it should be interpreted with caution due to the primitive analysis in a small population, the positive expression of NR2F1 showed a longer duration of disease-free survival (DFS) after conversion surgery (p = 0.016). In conclusion, conversion surgery showed a durable OS even in patients with initially metastatic gastric cancer when R0 resection was achieved after chemotherapy.

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Conversion surgery for gastric cancer: A cohort study from a western center

Abstract: Conversion gastrectomy, when R0 could be achieved, is associated with long survivals and it is the most important prognostic factor in patients with advanced gastric cancer. Further studies are needed to define the ideal patient who can really benefit from this treatment.

Cited by 53 publications

References 24 publications

Conversion surgery for gastric cancer patients: A review

Conversion surgery for gastric cancer patients: A review

Prognostic benefit of conversion surgery for HER2 positive stage IV gastric cancer; a case series study of eleven patients treated with trastuzumab-based chemotherapy

Conversion Surgery in Metastatic Gastric Cancer and Cancer Dormancy as a Prognostic Biomarker

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