Current status of conversion surgery for stage IV gastric cancer

Abstract

Palliative chemotherapy with best supportive care is a mainstay for patients with gastric cancer (GC) and distant metastasis. However, with advances in GC chemotherapy, multimodal treatment, including perioperative chemotherapy plus conversion surgery, has attracted attention as a new strategy to improve the outcome of patients with stage IV disease. Conversion surgery is defined as surgical treatment aimed at R0 resection after a good response to induction chemotherapy for tumors originally considered unresectable or marginally resectable for technical and/or oncological reasons. Various biological characteristics differ, depending on each metastatic condition in stage IV GC. The main metastatic pathways of GC can be divided into three categories: lymphatic, hematogenous, and peritoneal. In each category, considerable historical data on conversion surgery have demonstrated the benefits of individualized approaches. However, owing to the diversity of these conditions, a common definition, including the choice of induction chemotherapy, optimal timing of resection, and eligibility for conversion surgery, has not been established among surgical oncologists. Thus, we explore the current and future treatment options by reviewing the literature on this controversial topic comprehensively.

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Acknowledgments

We thank all members of the Department of Gastroenterological Surgery, Kanazawa University, Graduate School of Medicine for their support and suggestions.

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Correspondence to Sachio Fushida.

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Kinoshita, J., Yamaguchi, T., Moriyama, H. et al. Current status of conversion surgery for stage IV gastric cancer. Surg Today (2021). https://doi.org/10.1007/s00595-020-02222-0

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Keywords

  • Conversion surgery
  • Stage IV gastric cancer
  • Induction chemotherapy