Abstract
The prognosis of stage IV gastric cancer (GC) is poor, with palliative chemotherapy remaining the main therapeutic option. Studies increasingly indicate that patients with unresectable stage IV GC, who undergo gastrectomy with radical intention after responding to several regimens of combined chemotherapy, can achieve good survival outcomes. Thus, surgery aiming at radical resection for unresectable stage IV GC after combined chemotherapy has received increasing attention in recent years. This novel therapeutic strategy was defined as conversion surgery in patients with unresectable stage IV GC and it can associate with significant improved survival when R0 resection can be achieved. Despite the recent advances in conversion surgery for patients with unresectable stage IV GC, selection criteria for combination chemotherapy regimens, indications for conversion surgery, optimal timing to surgery, and postoperative chemotherapy all remain controversial. This article reviews the current state of conversion surgery for unresectable stage IV GC.
Highlights
Despite early screening and improved intensive therapy, gastric cancer (GC) remains to be the fifth most common cancer and third most common cause of cancer-related deaths worldwide, leading to increased health care burden [1, 2]
A single-arm phase II study of conversion surgery following eight cycles of IP paclitaxel with systemic oxaliplatin and capecitabine (XELOX) in unresectable GC patients with Peritoneal metastases (PM) and/or positive peritoneal washing cytology showed that six patients who underwent conversion gastrectomy, after a favorable response rate to combined XELOX and IP paclitaxel experienced a median survival time (MST) of 21.6 months, compared to patients receiving systemic chemotherapy alone in other trials who had MST of 3.1–10.6 months [50]
Yamaguchi et al reported that 20 stage IV GC patients with liver metastases (LM) underwent conversion surgery plus liver metastasectomy after chemotherapy with a conversion rate of 21.5% (20/93), and suggested that metastasectomy along with primary tumor resection might be feasible for this population, provided that the metastases respond well to chemotherapy [46]
Summary
Despite early screening and improved intensive therapy, gastric cancer (GC) remains to be the fifth most common cancer and third most common cause of cancer-related deaths worldwide, leading to increased health care burden [1, 2]. A single-arm phase II study of conversion surgery following eight cycles of IP paclitaxel with systemic oxaliplatin and capecitabine (XELOX) in unresectable GC patients with PM and/or positive peritoneal washing cytology showed that six patients who underwent conversion gastrectomy, after a favorable response rate to combined XELOX and IP paclitaxel experienced a MST of 21.6 months, compared to patients receiving systemic chemotherapy alone in other trials who had MST of 3.1–10.6 months [50].
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