Multidisciplinary treatment for patients with stage IV gastric cancer: the role of conversion surgery following chemotherapy
Seung-Hoon Beom,
Yoon Young Choi,
Song-Ee Baek,
Shuang-Xi Li,
Joon Seok Lim,
Taeil Son,
Hyoung-Il Kim,
Jae-Ho Cheong,
Woo Jin Hyung,
Seung Ho Choi,
Minkyu Jung,
Hyo Song Kim,
Hei-Cheul Jeung,
Hyun Cheol Chung,
Sun Young Rha,
Sung Hoon Noh
Affiliations
Seung-Hoon Beom
Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine
Yoon Young Choi
Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine
Song-Ee Baek
Department of Radiology, Yonsei University College of Medicine
Shuang-Xi Li
Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute
Joon Seok Lim
Department of Radiology, Yonsei University College of Medicine
Taeil Son
Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine
Hyoung-Il Kim
Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine
Jae-Ho Cheong
Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine
Woo Jin Hyung
Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine
Seung Ho Choi
Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine
Minkyu Jung
Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine
Hyo Song Kim
Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine
Hei-Cheul Jeung
Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine
Hyun Cheol Chung
Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine
Sun Young Rha
Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine
Sung Hoon Noh
Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine
Abstract Background With advances in gastric cancer chemotherapy, conversion surgery has drawn attention as a new strategy to improve the outcome of stage IV disease. We investigated the efficacy of conversion surgery following chemotherapy for patients with stage IV gastric cancer. Methods We retrospectively reviewed clinico-pathologic variables and oncologic outcomes for 101 patients with stage IV gastric cancer who were treated with systemic chemotherapy followed by gastrectomy with intension of curative resection from January 2005 to December 2012. Results In terms of the best response from palliative chemotherapy, complete or partial response were observed in 65 patients (64.4%) in overall. Complete response of metastatic site were observed in 72 (71.3%) and 66 (65.3%) patients as best and pre-operative response, respectively. The overall complete macroscopic resection, rate was 56.4%. Eleven patients (10.9%) received combined metastasectomy. There was no postoperative surgery-related mortality for 1 month. The median overall survival time was 26.0 months. Multivariable analysis identified complete macroscopic resection, chemotherapy response (complete response/partial response) of metastatic sites, and change in CEA level as independent prognostic factors contributing to overall survival. Conclusions Patients with stage IV gastric cancer who exhibit a good clinical response to chemotherapy might obtain greater survival benefit from gastrectomy following chemotherapy compared with patients who exhibit a poor response to chemotherapy. Prospective, randomized trials are required to determine the best strategy for combining initial chemotherapy with subsequent gastrectomy.
