Long-term survival and prognosis associated with conversion surgery in patients with metastatic gastric cancer

Abstract

In gastric cancer, primary systemic chemotherapy is the standard approach for the management of patients with initially unresectable metastasis, and it occasionally leads to a reduction in the size of the lesion, which facilitates surgical resection. The aim of this study was to examine the prognosis of patients who were able to undergo complete resection following chemotherapy. A total of 10 patients who underwent radical surgery for stage IV primary gastric cancer after chemotherapy between 2009 and 2015 at the Department of Surgery of Hokkaido Social Work Association Obihiro Hospital (Obihiro, Japan) were retrospectively investigated. Three regimens were used (S-1, n=1; S-1 + cisplatin, n=8; and S-1 + docetaxel, n=1). The mean time from chemotherapy to surgery was 210 days. One total gastrectomy + splenectomy + colectomy, one total gastrectomy + splenectomy, four total gastrectomies and three distal gastrectomies were performed. There were two cases of pancreatic fistula formation postoperatively. All the patients survived for >1 year. Of the 10 patients, 5 survived without recurrence. The median survival time was 871.1 days after diagnosis. Therefore, curative resection after chemotherapy is associated with a better prognosis in stage IV gastric cancer patients.

Conversion surgery for gastric cancer patients: A review

“…Ten patients with one incurable factor were retrospectively analyzed by Einama et al[ 82 ]. All cases were considered resectable after chemotherapy, achieving R0 resection.…”

“…The authors reported a longer survival of surgical patients compared with those who received chemo alone (MST 29 mo). Non-invasive macroscopic type, higher differentiation, and absence of peritoneal dissemination were all favorable survival predictors[ 82 ].…”

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

“…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].…”

“…This is because surgery is currently the only option for curative treatment in advanced gastric cancer. Consequently, previous reports that studied conversion surgery in metastatic gastric cancer have adopted observational study models [4,[6][7][8]10,[15][16][17][18][19][20]. For this reason, most previous studies have obvious inherent limitations associated with selection bias in patients who received conversion surgery, i.e., better initial response to systemic chemotherapy or a lesser degree of peritoneal seeding, compared with the group who only received palliative chemotherapy.…”

“…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.…”