Surgical treatment for metastatic gastric cancer

Abstract

The incidence of metastatic gastric cancer (MGC) is high and the prognosis is poor with 5-year survival rarely exceeding 5%. Systemic chemotherapy is the cornerstone for MGC in current treatment guidelines. Recent studies have revealed both reduction surgery and conversion surgery can improve patient's prognosis, indicating the value of surgical treatment in MGC. Based on the present therapeutic strategy, we discuss the indication, extent and timing of surgery for MGC. Our conclusions are as followings: the treatment of gastric cancer is chemotherapy-based, target-included and surgery-combined multidisciplinary therapy; patients with single non-curable factor are most likely to benefit from surgery-combined multidisciplinary therapy; the optimal timing for surgery depends on the response to chemotherapy; it is worthwhile to explore the conversion therapy combining target therapy and chemotherapy; the resection of metastasis lesion can be managed according to Japanese guideline; in order to establish high-level evidence, it is necessary to unite experts from different disciplines to conduct clinical trial according to the category of metastasis of gastric cancer.