Is there a role for treatment-oriented surgery in stage IV gastric cancer? A systematic review
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To analyze the available evidence on the role of treatment-oriented surgery in stage IV gastric cancer (metastatic disease), a systematic literature search was undertaken using Medline, Embase, Cochrane, and Web-of-Science libraries. The search was not restricted to articles published within a given year range. Articles written in English language (or with abstracts written in English) were considered. All references in the chosen articles were further screened to find additional relevant publications. Both clinical series and literature reviews were included. Stage IV gastric cancer is classified into four subcategories: positive peritoneal cytology without clear macroscopic peritoneal involvement (surgery is usually performed in these cases); gross appearance peritoneal carcinomatosis [surgery, eventually with hyperthermic intraoperative peritoneal chemotherapy (HIPEC) may be considered in very selected cases with limited PCI]; nodal metastases outside the loco-regional nodes (surgery may not be denied for metastatic nodes in stations 13 and 16); and hematogenous metastases (surgery should be performed in selected cases with liver metastases suitable to R0 resection). The analysis incorporated the new biological classification of stage IV gastric cancer recently proposed by Japanese researchers (Yoshida et al. in Gastric Cancer 19:329–338. https://doi.org/10.1007/s10120-015-0575-z, 2015) into the four aforementioned subcategories to make the comparison of the issues discussed meaningful. The take home message from the existing literature is that treatment-oriented surgery may be performed in a significant proportion of patients with stage IV gastric cancer.
KeywordsGastric cancer Stomach Staging TNM Metastases Nodal involvement Peritoneum Carcinomatosis
We thank Paolo Morgagni, Daniele Marrelli, Franco Roviello, Simone Giacopuzzi, and Giovanni De Manzoni on behalf of the Italian Research Group for Gastric Cancer (GIRCG) for their contributions in conceiving the manuscript, and Luca Arru for his contribution to the literature search strategy. We are grateful to RicerChiAmo Onlus (http://www.ricerchiamobrescia.it) for supporting this study.
All the authors made substantial contributions to conception and design of the study, acquisition of data, or analysis and interpretation of data, drafted the article or made critical revisions related to important intellectual content of the manuscript and finally approved the version of the article to be published. In particular, GLB conceived the study; SM wrote the paper; SM and ZB performed literature search and review; FG analyzed the data provided by SM and ZB; and FG, GLB, and NP reviewed the paper.
Compliance with ethical standards
Conflict of interest
All the authors declare that there is no potential personal conflict of interest or financial disclosures.
Research involving human participants and/or animals
The guidelines provided by the Committee on Publication Ethics (COPE) have been followed. This article does not contain any studies with human participants performed by any of the authors.
All the authors declare that the material has not been previously published or submitted elsewhere for publication and will not be sent to another journal until a decision will be made concerning publication by your journal, since the manuscript is a review of the literature, no informed consent was obtained.
- 3.Brierley J, Gospodarowicz MK, Wittekind C (2017) TNM classification of malignant tumours, 8th edn. Wiley, ChichesterGoogle Scholar
- 8.De Manzoni G, Baiocchi GL, Framarini M, De Giuli M, D’Ugo D, Marchet A, Nitti D, Marrelli D, Morgagni P, Rinnovati A, Rosati R, Roviello F, Allieta R, Berti S, Bracale U, Capelli P, Cavicchi A, Di Martino N, Donini A, Filippini A, Francioni G, Frascio M, Garofalo A, Giulini SM, Grassi GB, Innocenti P, Martino A, Mazzocconi G, Mazzola L, Montemurro S, Palasciano N, Pantuso G, Pernthaler H, Petri R, Piazza D, Sacco R, Sgroi G, Staudacher C, Testa M, Vallicelli C, Vettoretto N, Zingaretti C, Capussotti L, Morino M, Verdecchia GM (2014) The SIC-GIRCG 2013 consensus conference on gastric cancer. Updates Surg 66:1–6. https://doi.org/10.1007/s13304-014-0248-1 CrossRefGoogle Scholar
- 9.Rudloff U, Langan RC, Mullinax JE, Beane JD, Steinberg SM, Beresnev T, Webb CC, Walker M, Toomey MA, Schrump D, Pandalai P, Stojadinovic A, Avital I (2014) Impact of maximal cytoreductive surgery plus regional heated intraperitoneal chemotherapy (HIPEC) on outcome of patients with peritoneal carcinomatosis of gastric origin: results of the GYMSSA trial. J Surg Oncol 110:275–284. https://doi.org/10.1002/jso.23633 CrossRefGoogle Scholar
- 12.Di Leo A, Marrelli D, Roviello F, Bernini M, Minicozzi A, Giacopuzzi S, Pedrazzani C, Baiocchi GL, de Manzoni G (2007) Lymph node involvement in gastric cancer for different tumor sites and T stage: Italian Research Group for Gastric Cancer (IRGGC) experience. J Gastrointest Surg 11:1146–1153CrossRefGoogle Scholar
- 15.Tsuburaya A, Mizusawa J, Tanaka Y, Fukushima N, Nashimoto A, Sasako M, Stomach Cancer Study Group of the Japan Clinical Oncology Group (2014) Neoadjuvant chemotherapy with S-1 and cisplatin followed by D2 gastrectomy with para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis. Br J Surg 101:653–660. https://doi.org/10.1002/bjs.9484 CrossRefGoogle Scholar
- 18.Adam R, Chiche L, Aloia T, Elias D, Salmon R, Rivoire M, Jaeck D, Saric J, Le Treut YP, Belghiti J, Mantion G, Mentha G, the Association Française de Chirurgie (2006) Hepatic resection for noncolorectal nonendocrine liver metastases. Analysis of 1452 patients and development of a prognostic model. Ann Surg 244:524–535. https://doi.org/10.1097/01.sla.0000239036.46827.5f CrossRefGoogle Scholar
- 19.Shirabe K, Wakiyama S, Gion T, Watanabe M, Miyazaki M, Yoshinaga K, Tokunaga M, Nagaie T (2006) Hepatic resection for the treatment of liver metastases in gastric carcinoma: review of the literature. HPB (Oxford) 8:89–92. https://doi.org/10.1080/13651820500472168 (PMID: 18333252) CrossRefGoogle Scholar
- 21.Tiberio GA, Baiocchi GL, Morgagni P, Marrelli D, Marchet A, Cipollari C, Graziosi L, Ministrini S, Vittimberga G, Donini A, Nitti D, Roviello F, Coniglio A, de Manzoni G (2015) Gastric cancer and synchronous hepatic metastases: is it possible to recognize candidates to R0 resection? Ann Surg Oncol 22:589–596. https://doi.org/10.1245/s10434-014-4018-6 CrossRefGoogle Scholar
- 22.Tiberio GA, Coniglio A, Marchet A, Marrelli D, Giacopuzzi S, Baiocchi GL, Roviello F, de Manzoni G, Nitti D, Giulini SM (2009) Metachronous hepatic metastases from gastric carcinoma: a multicentric survey. Eur J Surg Oncol 35:486–491. https://doi.org/10.1016/j.ejso.2008.12.017 CrossRefGoogle Scholar
- 23.Fujitani K, Yang HK, Mizusawa J, Kim YW, Terashima M, Han SU, Iwasaki Y, Hyung WJ, Takagane A, Park do J, Yoshikawa T, Hahn S, Nakamura K, Park CH, Kurokawa Y, Bang YJ, Park BJ, Sasako M, Tsujinaka T, REGATTA Study Investigators (2016) 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 17:309–318. https://doi.org/10.1016/s1470-2045(15)00553-7 CrossRefGoogle Scholar
- 24.Graziosi L, Cantarella F, Mingrone E, Gunnellini M, Cavazzoni E, Liberati M, Donini A (2013) Preliminary results of prophylactic HIPEC in patients with locally advanced gastric cancer. Ann Ital Chir 84:551–556Google Scholar
- 25.Moriwaki Y, Kunisaki C, Kobayashi S, Harada H, Imai S, Kasaoka C (2004) Does the surgical stress associated with palliative resection for patients with incurable gastric cancer with distant metastasis shorten their survival? Hepatogastroenterology 51(57):872–875Google Scholar
- 29.Baiocchi GL, Marrelli D, Verlato G, Morgagni P, Giacopuzzi S, Coniglio A, Marchet A, Rosa F, Capponi MG, Di Leo A, Saragoni L, Ansaloni L, Pacelli F, Nitti D, D’Ugo D, Roviello F, Tiberio GA, Giulini SM, De Manzoni G (2014) Follow up after gastrectomy for cancer: an appraisal of the Italian Research Group for Gastric Cancer. Ann Surg Oncol 21:2005–2011. https://doi.org/10.1245/s10434-014-3534-8 Google Scholar
- 30.Baiocchi GL, D’Ugo D, Coit D, Hardwick R, Kassab P, Nashimoto A, Marrelli D, Allum W, Berruti A, Chandramohan SM, Coburn N, Gonzàlez-Moreno S, Hoelscher A, Jansen E, Leja M, Mariette C, Meyer HJ, Mönig S, Morgagni P, Ott K, Preston S, Rha SY, Roviello F, Sano T, Sasako M, Shimada H, Schuhmacher C, So Bok-Yan J, Strong V, Yoshikawa T, Terashima M, Ter-Ovanesov M, Van der Velde C, Memo M, Castelli F, Pecorelli S, Detogni C, Kodera Y, de Manzoni G (2016) Follow-up after gastrectomy for cancer: the Charter Scaligero consensus conference. Gastric Cancer 19:15–20. https://doi.org/10.1007/s10120-015-0513-0 CrossRefGoogle Scholar