Outcomes of Conversion Surgery for Metastatic Gastric Cancer Compared with In-Front Surgery Plus Palliative Chemotherapy or In-Front Surgery Alone

Abstract

The survival benefits of conversion surgery in patients with metastatic gastric cancer (mGC) remain unclear. Thus, this study aimed to determine the outcomes of conversion surgery compared to in-front surgery plus palliative chemotherapy (PCT) or in-front surgery alone for mGC. We recruited 182 consecutive patients with mGC who underwent gastrectomy, including conversion surgery, in-front surgery plus PCT, and in-front surgery alone at Linkou Chang Gung Memorial Hospital from 2011 to 2019. The tumor was staged according to the 8th edition of the American Joint Committee on Cancer. Patient demographics and clinicopathological factors were assessed. Overall survival (OS) was evaluated using the Kaplan–Meier curve and compared among groups. Conversion surgery showed a significantly longer median OS than in-front surgery plus PCT or in-front surgery alone (23.4 vs. 13.7 vs. 5.6 months; log rank p < 0.0001). The median OS of patients with downstaging (pathological stage I–III) was longer than that of patients without downstaging (stage IV) (30.9 vs. 18.0 months; p = 0.016). Our study shows that conversion surgery is associated with survival benefits compared to in-front surgery plus PCT or in-front surgery alone in patients with mGC. Patients who underwent conversion surgery with downstaging had a better prognosis than those without downstaging.

The Clinical Implication of Conversion Surgery in Patients with Stage IV Gastric Cancer Who Received Systemic Chemotherapy

“…In contrast, a metastatic pattern was not significantly associated with prognosis, nor were comorbidities. This is in agreement with results from previous studies that demonstrate no survival difference between initial metastatic sites [15,21,22]. Favorable long-term survival in patients with multiple metastases in our results is unreasonable, and this may be because patients with multiple metastases who received conversion surgery were highly responsive to chemotherapy; only patients whose multiple metastatic tumors regressed very well after chemotherapy could be selected for surgery, and thus their great chemosensitivity might have led to favorable long-term survival.…”

“…So-called "conversion surgery" benefits from higher R0 resection and pathological response rates, as well as the clearance of free cancer cells in the peritoneal cavity. Indeed, retrospective analyses, including a meta-analysis and nationwide analysis, demonstrated the survival benefit of conversion surgery compared to primary gastrectomy, plus postoperative chemotherapy or chemotherapy alone [13][14][15]. In addition, a prospective phase 2 trial (AIO-FLOT3) had a median OS of 22.9 months for patients with limited metastatic gastric cancer treated via conversion surgery [16].…”

“…Given the importance of the proper selection of candidates for conversion surgery aimed at curative R0 resection, recent studies on conversion surgery focused on factors associated with survival [14,15,17,[19][20][21][22][23][24][25]. Multivariable analyses identified several prognostic factors that can be divided by their timing of clinical acquisition [19,20,[22][23][24].…”

Some Concerns from a Radiological Point of View. Comment on Huang et al. Outcomes of Conversion Surgery for Metastatic Gastric Cancer Compared with In-Front Surgery Plus Palliative Chemotherapy or In-Front Surgery Alone. J. Pers. Med. 2022, 12, 555

“…We read, with great interest, the article by Huang Ruo-Yi and colleagues entitled “Outcomes of Conversion Surgery for Metastatic Gastric Cancer Compared with In-Front Surgery Plus Palliative Chemotherapy or In-Front Surgery Alone”, published on 1 April 2022 [ 1 ].…”

Reply to Mazzei et al. Some Concerns from a Radiological Point of View. Comment on “Huang et al. Outcomes of Conversion Surgery for Metastatic Gastric Cancer Compared with In-Front Surgery plus Palliative Chemotherapy or In-Front Surgery Alone. J. Pers. Med. 2022, 12, 555”

“…We thank the authors for their interest in our article “Outcomes of Conversion Surgery for Metastatic Gastric Cancer Compared with In-Front Surgery Plus Palliative Chemotherapy or In-Front Surgery Alone” [ 1 ]. We also acknowledge their critical insight and sharing their data regarding the evaluation on peritoneal carcinomatosis [ 2 ].…”