Advertisement

Gastric Cancer

, Volume 22, Issue 6, pp 1285–1293 | Cite as

Conversion gastrectomy for stage IV unresectable gastric cancer: a GIRCG retrospective cohort study

  • Leonardo Solaini
  • Silvia Ministrini
  • Maria Bencivenga
  • Alessia D’Ignazio
  • Elisabetta Marino
  • Chiara Cipollari
  • Beatrice Molteni
  • Gianni Mura
  • Daniele Marrelli
  • Luigina Graziosi
  • Franco Roviello
  • Giovanni De Manzoni
  • Guido A. M. Tiberio
  • Paolo MorgagniEmail author
Original Article

Abstract

Background

The aim of this study is to report the experience with conversion surgery from six Gruppo Italiano Ricerca Cancro Gastrico (GIRCG) centers, focusing our analysis on factors affecting survival and the risk of recurrence.

Methods

A retrospective, multicenter cohort study was performed in patients who had undergone conversion gastrectomy between 2005 and 2017. Data were extracted from a GIRCG database including all metastatic gastric cancer patients submitted to surgery. Only stage IV unresectable tumors/metastases which became resectable after chemotherapy were included in this analysis.

Results

Forty-five resected M1 patients were included in the analysis. Reasons for being deemed unresectable at diagnosis were peritoneal involvement (PCI > 6) (n = 38, 84.4%), distant metastatic nodes (n = 3, 6.6%) and extensive liver involvement (n = 4, 8.8%). Median follow-up was 25 months (IQR 9-50). Median overall survival from surgery was 15 months and 1-, 3- and 5-year survivals were 57.2, 36.1 and 24%, respectively. Median progression-free survival was 12 months with 1- and 3-year survival of 46.4 and 33.9%, respectively. At cox regression analysis the only independent prognostic factor for OS was the presence of more than one type of metastasis (HR 4.41, 95% CI 1.72–11.3, p = 0.002). A positive microscopic resection margin was the only risk factor for recurrence (HR 5.72, 95% CI 1.04–31.4, p = 0.045).

Conclusions

Unresectable stage IV GC patients could benefit from radical surgery after chemotherapy and achieve long survivals. The main prognostic factor for these patients was the presence of more than one type of extra-gastric metastatic involvement.

Keywords

Stage IV gastric cancer Conversion surgery Palliative chemotherapy Metastases Gastrectomy Survival 

Notes

Compliance with ethical standards

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20:1–19.Google Scholar
  2. 2.
    De Manzoni G, Marrelli D, Baiocchi GL, Morgagni P, Saragoni L, Degiuli M, et al. The Italian Research Group for Gastric Cancer (GIRCG) guidelines for gastric cancer staging and treatment: 2015. Gastric Cancer. 2017;20:20–30.CrossRefGoogle Scholar
  3. 3.
    Shah MA. Update on metastatic gastric and esophageal cancers. J Clin Oncol. 2015;33:1760–9.CrossRefGoogle Scholar
  4. 4.
    Einama T, Abe H, Shichi S, Matsui H, Kanazawa R, Shibuya K, et al. Long-term survival and prognosis associated with conversion surgery in patients with metastatic gastric cancer. Mol Clin Oncol. 2017;6:163–6.CrossRefGoogle Scholar
  5. 5.
    Fukuchi M, Ishiguro T, Ogata K, Suzuki O, Kumagai Y, Ishibashi K, et al. Prognostic role of conversion surgery for unresectable gastric cancer. Ann Surg Oncol. 2015;22:3618–24.CrossRefGoogle Scholar
  6. 6.
    Kinoshita J, Fushida S, Tsukada T, Oyama K, Okamoto K, Makino I, et al. Efficacy of conversion gastrectomy following docetaxel, cisplatin, and S-1 therapy in potentially resectable stage IV gastric cancer. Eur J Surg Oncol. 2015;41:1354–60.CrossRefGoogle Scholar
  7. 7.
    Morgagni P, Solaini L, Framarini M, Vittimberga G, Gardini A, Tringali D, et al. Conversion surgery for gastric cancer: a cohort study from a western center. Int J Surg. 2018;53:360–5.CrossRefGoogle Scholar
  8. 8.
    Nakajima T, Ota K, Ishihara S, Oyama S, Nishi M, Ohashi Y, et al. Combined intensive chemotherapy and radical surgery for incurable gastric cancer. Ann Surg Oncol. 1997;4:203–8.CrossRefGoogle Scholar
  9. 9.
    Saito M, Kiyozaki H, Takata O, Suzuki K, Rikiyama T. Treatment of stage IV gastric cancer with induction chemotherapy using S-1 and cisplatin followed by curative resection in selected patients. World J Surg Oncol. 2014;12:406.CrossRefGoogle Scholar
  10. 10.
    Sato Y, Ohnuma H, Nobuoka T, Hirakawa M, Sagawa T, Fujikawa K, et al. Conversion therapy for inoperable advanced gastric cancer patients by docetaxel, cisplatin, and S-1 (DCS) chemotherapy: a multi-institutional retrospective study. Gastric Cancer. 2017;20:517–26.CrossRefGoogle Scholar
  11. 11.
    Yamaguchi K, Yoshida K, Tanahashi T, Takahashi T, Matsuhashi N, Tanaka Y, et al. The long-term survival of stage IV gastric cancer patients with conversion therapy. Gastric Cancer. 2017;21:315–23.CrossRefGoogle Scholar
  12. 12.
    Terashima M. Conversion therapy for gastric cancer: who can make conversion as successful as Goromaru? Gastric Cancer. 2016;19:685–6.CrossRefGoogle Scholar
  13. 13.
    Sugarbaker PH. A curative approach to peritoneal carcinomatosis from colorectal cancer. Semin Oncol. 2005;32:S68–73.CrossRefGoogle Scholar
  14. 14.
    Lauren P. The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma: an attempt at a histo-clinical classification. Acta Pathol Microbiol Scand. 1965;64:31–49.CrossRefGoogle Scholar
  15. 15.
    Edge S, Byrd D, Compton C. AJCC Cancer Staging Manual, edn 7. New York: Springer; 2010.Google Scholar
  16. 16.
    Yoshida K, Yamaguchi K, Okumura N, Tanahashi T, Kodera Y. Is conversion therapy possible in stage IV gastric cancer: the proposal of new biological categories of classification. Gastric Cancer. 2016;19:329–38.CrossRefGoogle Scholar
  17. 17.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefGoogle Scholar
  18. 18.
    Schemper M, Smith TL. A note on quantifying follow-up in studies of failure time. Control Clin Trials. 1996;17:343–6.CrossRefGoogle Scholar
  19. 19.
    Kanda T, Yajima K, Kosugi S, Ishikawa T, Ajioka Y, Hatakeyama K. Gastrectomy as a secondary surgery for stage IV gastric cancer patients who underwent S-1-based chemotherapy: a multi-institute retrospective study. Gastric Cancer. 2012;15:235–44.CrossRefGoogle Scholar
  20. 20.
    Mieno H, Yamashita K, Hosoda K, Moriya H, Higuchi K, Azuma M, et al. Conversion surgery after combination chemotherapy of docetaxel, cisplatin and S-1 (DCS) for far-advanced gastric cancer. Surg Today. 2017;47:1249–58.CrossRefGoogle Scholar
  21. 21.
    Okabe H, Ueda S, Obama K, Hosogi H, Sakai Y. Induction chemotherapy with S-1 plus cisplatin followed by surgery for treatment of gastric cancer with peritoneal dissemination. Ann Surg Oncol. 2009;16:3227–36.CrossRefGoogle Scholar
  22. 22.
    Uemura N, Kikuchi S, Sato Y, Ohnuma H, Okamoto K, Miyamoto H, et al. A phase II study of modified docetaxel, cisplatin, and S-1 (mDCS) chemotherapy for unresectable advanced gastric cancer. Cancer Chemother Pharmacol. 2017;80:707–13.CrossRefGoogle Scholar
  23. 23.
    Fujitani K, Yang HK, Mizusawa J, Kim YW, Terashima M, Han SU, et al. Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trial. Lancet Oncol. 2016;17:309–18.CrossRefGoogle Scholar

Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2019

Authors and Affiliations

  • Leonardo Solaini
    • 1
  • Silvia Ministrini
    • 2
  • Maria Bencivenga
    • 3
  • Alessia D’Ignazio
    • 4
  • Elisabetta Marino
    • 5
  • Chiara Cipollari
    • 3
  • Beatrice Molteni
    • 2
  • Gianni Mura
    • 6
  • Daniele Marrelli
    • 4
  • Luigina Graziosi
    • 5
  • Franco Roviello
    • 4
  • Giovanni De Manzoni
    • 3
  • Guido A. M. Tiberio
    • 2
  • Paolo Morgagni
    • 1
    Email author
  1. 1.General and Oncologic Surgery, Department of SurgeryMorgagni-Pierantoni HospitalForlìItaly
  2. 2.Department of Experimental and Clinical SciencesUniversity of BresciaBresciaItaly
  3. 3.General and Upper GI Surgery DivisionUniversity of VeronaVeronaItaly
  4. 4.Department of SurgeryPoliclinico le Scotte- University of SienaSienaItaly
  5. 5.Department of SurgerySanta Maria della Misericordia Hospital University of PerugiaPerugiaItaly
  6. 6.Department of SurgeryAzienda USl Toscana SudEst- ArezzoArezzoItaly

Personalised recommendations