Conversion surgery for stage IV gastric cancer: a multicenter retrospective study

Background Recent improvements in systemic chemotherapy have provided an opportunity for patients with stage IV gastric cancer (GC) to undergo conversion surgery (CS). The aim of this study was to evaluate the long-term outcomes of patients who underwent CS and to elucidate the prognostic factors fo...

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Veröffentlicht in:	BMC surgery Jg. 22; H. 1; S. 428 - 9
Hauptverfasser:	Kano, Yosuke, Ichikawa, Hiroshi, Hanyu, Takaaki, Muneoka, Yusuke, Ishikawa, Takashi, Aizawa, Masaki, Matsuki, Atsushi, Yabusaki, Hiroshi, Bamba, Takeo, Nakagawa, Satoru, Kobayashi, Kazuaki, Kuwabara, Shirou, Makino, Shigeto, Kawachi, Yasuyuki, Naito, Tetsuya, Tani, Tatsuo, Hirukawa, Hiroshi, Tada, Tetsuya, Shimada, Yoshifumi, Sakata, Jun, Wakai, Toshifumi
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	London BioMed Central 14.12.2022 BioMed Central Ltd Springer Nature B.V BMC
Schlagworte:	Aorta Cancer Chemotherapy Classification Conversion Conversion surgery Cytology Dissection Gastrectomy Gastric cancer Gastrointestinal surgery Humans Internal Medicine Liver Lymph nodes Lymphatic system Medical prognosis Medicine Medicine & Public Health Metastases Metastasis Multivariate analysis Neoplasm Staging Oncology, Experimental Patients Peritoneum Prognosis Retrospective Studies Stage IV Statistical analysis Stomach cancer Stomach Neoplasms - pathology Surgery Surgical outcomes Survival analysis Tomography Gastric cancer Conversion surgery Stage IV
ISSN:	1471-2482, 1471-2482
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Abstract	Background Recent improvements in systemic chemotherapy have provided an opportunity for patients with stage IV gastric cancer (GC) to undergo conversion surgery (CS). The aim of this study was to evaluate the long-term outcomes of patients who underwent CS and to elucidate the prognostic factors for CS in stage IV GC. Methods A total of 79 patients who underwent CS with the aim of R0 resection for stage IV GC at six institutions from January 2008 to July 2019 were enrolled. We retrospectively reviewed the clinicopathological data and prognosis. Results Of the 79 patients, 23 (31.1%) had initially resectable disease (IR) before chemotherapy, defined as positive for cancer on peritoneal cytology (CY1), resectable hepatic metastasis, or para-aortic lymph node No. 16a2/b1 metastasis. Of the 56 remaining patients with primary unresectable disease, 39 had peritoneal dissemination. R0 resection was accomplished in 63 patients (79.7%). The 3-year OS rates for patients with IR and unresectable disease were 78.3% and 44.5%, respectively. Multivariate analysis showed that IR ( P = 0.014) and R0 ( P = 0.014) were statistically significant independent prognostic factors for favorable OS. Among patients with peritoneal dissemination alone, OS was significantly better for patients with R0 resection than for patients with R1/2 resection, with the 3-year OS rates of 65.5% and 23.1%, respectively ( P = 0.011). Conclusions CS is a treatment option for selected patients with stage IV GC. Patients with IR and patients who achieve R0 resection may obtain a survival benefit from CS.
AbstractList	Background Recent improvements in systemic chemotherapy have provided an opportunity for patients with stage IV gastric cancer (GC) to undergo conversion surgery (CS). The aim of this study was to evaluate the long-term outcomes of patients who underwent CS and to elucidate the prognostic factors for CS in stage IV GC. Methods A total of 79 patients who underwent CS with the aim of R0 resection for stage IV GC at six institutions from January 2008 to July 2019 were enrolled. We retrospectively reviewed the clinicopathological data and prognosis. Results Of the 79 patients, 23 (31.1%) had initially resectable disease (IR) before chemotherapy, defined as positive for cancer on peritoneal cytology (CY1), resectable hepatic metastasis, or para-aortic lymph node No. 16a2/b1 metastasis. Of the 56 remaining patients with primary unresectable disease, 39 had peritoneal dissemination. R0 resection was accomplished in 63 patients (79.7%). The 3-year OS rates for patients with IR and unresectable disease were 78.3% and 44.5%, respectively. Multivariate analysis showed that IR (P = 0.014) and R0 (P = 0.014) were statistically significant independent prognostic factors for favorable OS. Among patients with peritoneal dissemination alone, OS was significantly better for patients with R0 resection than for patients with R1/2 resection, with the 3-year OS rates of 65.5% and 23.1%, respectively (P = 0.011). Conclusions CS is a treatment option for selected patients with stage IV GC. Patients with IR and patients who achieve R0 resection may obtain a survival benefit from CS. Keywords: Gastric cancer, Stage IV, Conversion surgery Recent improvements in systemic chemotherapy have provided an opportunity for patients with stage IV gastric cancer (GC) to undergo conversion surgery (CS). The aim of this study was to evaluate the long-term outcomes of patients who underwent CS and to elucidate the prognostic factors for CS in stage IV GC. A total of 79 patients who underwent CS with the aim of R0 resection for stage IV GC at six institutions from January 2008 to July 2019 were enrolled. We retrospectively reviewed the clinicopathological data and prognosis. Of the 79 patients, 23 (31.1%) had initially resectable disease (IR) before chemotherapy, defined as positive for cancer on peritoneal cytology (CY1), resectable hepatic metastasis, or para-aortic lymph node No. 16a2/b1 metastasis. Of the 56 remaining patients with primary unresectable disease, 39 had peritoneal dissemination. R0 resection was accomplished in 63 patients (79.7%). The 3-year OS rates for patients with IR and unresectable disease were 78.3% and 44.5%, respectively. Multivariate analysis showed that IR (P = 0.014) and R0 (P = 0.014) were statistically significant independent prognostic factors for favorable OS. Among patients with peritoneal dissemination alone, OS was significantly better for patients with R0 resection than for patients with R1/2 resection, with the 3-year OS rates of 65.5% and 23.1%, respectively (P = 0.011). CS is a treatment option for selected patients with stage IV GC. Patients with IR and patients who achieve R0 resection may obtain a survival benefit from CS. Recent improvements in systemic chemotherapy have provided an opportunity for patients with stage IV gastric cancer (GC) to undergo conversion surgery (CS). The aim of this study was to evaluate the long-term outcomes of patients who underwent CS and to elucidate the prognostic factors for CS in stage IV GC.BACKGROUNDRecent improvements in systemic chemotherapy have provided an opportunity for patients with stage IV gastric cancer (GC) to undergo conversion surgery (CS). The aim of this study was to evaluate the long-term outcomes of patients who underwent CS and to elucidate the prognostic factors for CS in stage IV GC.A total of 79 patients who underwent CS with the aim of R0 resection for stage IV GC at six institutions from January 2008 to July 2019 were enrolled. We retrospectively reviewed the clinicopathological data and prognosis.METHODSA total of 79 patients who underwent CS with the aim of R0 resection for stage IV GC at six institutions from January 2008 to July 2019 were enrolled. We retrospectively reviewed the clinicopathological data and prognosis.Of the 79 patients, 23 (31.1%) had initially resectable disease (IR) before chemotherapy, defined as positive for cancer on peritoneal cytology (CY1), resectable hepatic metastasis, or para-aortic lymph node No. 16a2/b1 metastasis. Of the 56 remaining patients with primary unresectable disease, 39 had peritoneal dissemination. R0 resection was accomplished in 63 patients (79.7%). The 3-year OS rates for patients with IR and unresectable disease were 78.3% and 44.5%, respectively. Multivariate analysis showed that IR (P = 0.014) and R0 (P = 0.014) were statistically significant independent prognostic factors for favorable OS. Among patients with peritoneal dissemination alone, OS was significantly better for patients with R0 resection than for patients with R1/2 resection, with the 3-year OS rates of 65.5% and 23.1%, respectively (P = 0.011).RESULTSOf the 79 patients, 23 (31.1%) had initially resectable disease (IR) before chemotherapy, defined as positive for cancer on peritoneal cytology (CY1), resectable hepatic metastasis, or para-aortic lymph node No. 16a2/b1 metastasis. Of the 56 remaining patients with primary unresectable disease, 39 had peritoneal dissemination. R0 resection was accomplished in 63 patients (79.7%). The 3-year OS rates for patients with IR and unresectable disease were 78.3% and 44.5%, respectively. Multivariate analysis showed that IR (P = 0.014) and R0 (P = 0.014) were statistically significant independent prognostic factors for favorable OS. Among patients with peritoneal dissemination alone, OS was significantly better for patients with R0 resection than for patients with R1/2 resection, with the 3-year OS rates of 65.5% and 23.1%, respectively (P = 0.011).CS is a treatment option for selected patients with stage IV GC. Patients with IR and patients who achieve R0 resection may obtain a survival benefit from CS.CONCLUSIONSCS is a treatment option for selected patients with stage IV GC. Patients with IR and patients who achieve R0 resection may obtain a survival benefit from CS. Background Recent improvements in systemic chemotherapy have provided an opportunity for patients with stage IV gastric cancer (GC) to undergo conversion surgery (CS). The aim of this study was to evaluate the long-term outcomes of patients who underwent CS and to elucidate the prognostic factors for CS in stage IV GC. Methods A total of 79 patients who underwent CS with the aim of R0 resection for stage IV GC at six institutions from January 2008 to July 2019 were enrolled. We retrospectively reviewed the clinicopathological data and prognosis. Results Of the 79 patients, 23 (31.1%) had initially resectable disease (IR) before chemotherapy, defined as positive for cancer on peritoneal cytology (CY1), resectable hepatic metastasis, or para-aortic lymph node No. 16a2/b1 metastasis. Of the 56 remaining patients with primary unresectable disease, 39 had peritoneal dissemination. R0 resection was accomplished in 63 patients (79.7%). The 3-year OS rates for patients with IR and unresectable disease were 78.3% and 44.5%, respectively. Multivariate analysis showed that IR ( P = 0.014) and R0 ( P = 0.014) were statistically significant independent prognostic factors for favorable OS. Among patients with peritoneal dissemination alone, OS was significantly better for patients with R0 resection than for patients with R1/2 resection, with the 3-year OS rates of 65.5% and 23.1%, respectively ( P = 0.011). Conclusions CS is a treatment option for selected patients with stage IV GC. Patients with IR and patients who achieve R0 resection may obtain a survival benefit from CS. Background Recent improvements in systemic chemotherapy have provided an opportunity for patients with stage IV gastric cancer (GC) to undergo conversion surgery (CS). The aim of this study was to evaluate the long-term outcomes of patients who underwent CS and to elucidate the prognostic factors for CS in stage IV GC. Methods A total of 79 patients who underwent CS with the aim of R0 resection for stage IV GC at six institutions from January 2008 to July 2019 were enrolled. We retrospectively reviewed the clinicopathological data and prognosis. Results Of the 79 patients, 23 (31.1%) had initially resectable disease (IR) before chemotherapy, defined as positive for cancer on peritoneal cytology (CY1), resectable hepatic metastasis, or para-aortic lymph node No. 16a2/b1 metastasis. Of the 56 remaining patients with primary unresectable disease, 39 had peritoneal dissemination. R0 resection was accomplished in 63 patients (79.7%). The 3-year OS rates for patients with IR and unresectable disease were 78.3% and 44.5%, respectively. Multivariate analysis showed that IR (P = 0.014) and R0 (P = 0.014) were statistically significant independent prognostic factors for favorable OS. Among patients with peritoneal dissemination alone, OS was significantly better for patients with R0 resection than for patients with R1/2 resection, with the 3-year OS rates of 65.5% and 23.1%, respectively (P = 0.011). Conclusions CS is a treatment option for selected patients with stage IV GC. Patients with IR and patients who achieve R0 resection may obtain a survival benefit from CS. Recent improvements in systemic chemotherapy have provided an opportunity for patients with stage IV gastric cancer (GC) to undergo conversion surgery (CS). The aim of this study was to evaluate the long-term outcomes of patients who underwent CS and to elucidate the prognostic factors for CS in stage IV GC. A total of 79 patients who underwent CS with the aim of R0 resection for stage IV GC at six institutions from January 2008 to July 2019 were enrolled. We retrospectively reviewed the clinicopathological data and prognosis. Of the 79 patients, 23 (31.1%) had initially resectable disease (IR) before chemotherapy, defined as positive for cancer on peritoneal cytology (CY1), resectable hepatic metastasis, or para-aortic lymph node No. 16a2/b1 metastasis. Of the 56 remaining patients with primary unresectable disease, 39 had peritoneal dissemination. R0 resection was accomplished in 63 patients (79.7%). The 3-year OS rates for patients with IR and unresectable disease were 78.3% and 44.5%, respectively. Multivariate analysis showed that IR (P = 0.014) and R0 (P = 0.014) were statistically significant independent prognostic factors for favorable OS. Among patients with peritoneal dissemination alone, OS was significantly better for patients with R0 resection than for patients with R1/2 resection, with the 3-year OS rates of 65.5% and 23.1%, respectively (P = 0.011). CS is a treatment option for selected patients with stage IV GC. Patients with IR and patients who achieve R0 resection may obtain a survival benefit from CS. Abstract Background Recent improvements in systemic chemotherapy have provided an opportunity for patients with stage IV gastric cancer (GC) to undergo conversion surgery (CS). The aim of this study was to evaluate the long-term outcomes of patients who underwent CS and to elucidate the prognostic factors for CS in stage IV GC. Methods A total of 79 patients who underwent CS with the aim of R0 resection for stage IV GC at six institutions from January 2008 to July 2019 were enrolled. We retrospectively reviewed the clinicopathological data and prognosis. Results Of the 79 patients, 23 (31.1%) had initially resectable disease (IR) before chemotherapy, defined as positive for cancer on peritoneal cytology (CY1), resectable hepatic metastasis, or para-aortic lymph node No. 16a2/b1 metastasis. Of the 56 remaining patients with primary unresectable disease, 39 had peritoneal dissemination. R0 resection was accomplished in 63 patients (79.7%). The 3-year OS rates for patients with IR and unresectable disease were 78.3% and 44.5%, respectively. Multivariate analysis showed that IR (P = 0.014) and R0 (P = 0.014) were statistically significant independent prognostic factors for favorable OS. Among patients with peritoneal dissemination alone, OS was significantly better for patients with R0 resection than for patients with R1/2 resection, with the 3-year OS rates of 65.5% and 23.1%, respectively (P = 0.011). Conclusions CS is a treatment option for selected patients with stage IV GC. Patients with IR and patients who achieve R0 resection may obtain a survival benefit from CS.
ArticleNumber	428
Audience	Academic
Author	Sakata, Jun Makino, Shigeto Ishikawa, Takashi Nakagawa, Satoru Kano, Yosuke Hanyu, Takaaki Hirukawa, Hiroshi Matsuki, Atsushi Kobayashi, Kazuaki Shimada, Yoshifumi Kuwabara, Shirou Aizawa, Masaki Kawachi, Yasuyuki Tada, Tetsuya Tani, Tatsuo Muneoka, Yusuke Yabusaki, Hiroshi Ichikawa, Hiroshi Wakai, Toshifumi Naito, Tetsuya Bamba, Takeo
Author_xml	– sequence: 1 givenname: Yosuke surname: Kano fullname: Kano, Yosuke organization: Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences – sequence: 2 givenname: Hiroshi surname: Ichikawa fullname: Ichikawa, Hiroshi email: hichikawa-nii@med.niigata-u.ac.jp organization: Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences – sequence: 3 givenname: Takaaki surname: Hanyu fullname: Hanyu, Takaaki organization: Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Department of Surgery, Shibata Prefectural Hospital – sequence: 4 givenname: Yusuke surname: Muneoka fullname: Muneoka, Yusuke organization: Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences – sequence: 5 givenname: Takashi surname: Ishikawa fullname: Ishikawa, Takashi organization: Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences – sequence: 6 givenname: Masaki surname: Aizawa fullname: Aizawa, Masaki organization: Department of Gastroenterological Surgery, Niigata Cancer Center Hospital – sequence: 7 givenname: Atsushi surname: Matsuki fullname: Matsuki, Atsushi organization: Department of Gastroenterological Surgery, Niigata Cancer Center Hospital – sequence: 8 givenname: Hiroshi surname: Yabusaki fullname: Yabusaki, Hiroshi organization: Department of Gastroenterological Surgery, Niigata Cancer Center Hospital – sequence: 9 givenname: Takeo surname: Bamba fullname: Bamba, Takeo organization: Department of Gastroenterological Surgery, Niigata Cancer Center Hospital – sequence: 10 givenname: Satoru surname: Nakagawa fullname: Nakagawa, Satoru organization: Department of Gastroenterological Surgery, Niigata Cancer Center Hospital – sequence: 11 givenname: Kazuaki surname: Kobayashi fullname: Kobayashi, Kazuaki organization: Department of Surgery, Niigata City General Hospital – sequence: 12 givenname: Shirou surname: Kuwabara fullname: Kuwabara, Shirou organization: Department of Surgery, Niigata City General Hospital – sequence: 13 givenname: Shigeto surname: Makino fullname: Makino, Shigeto organization: Department of Surgery, Nagaoka Chuo General Hospital – sequence: 14 givenname: Yasuyuki surname: Kawachi fullname: Kawachi, Yasuyuki organization: Department of Surgery, Nagaoka Chuo General Hospital – sequence: 15 givenname: Tetsuya surname: Naito fullname: Naito, Tetsuya organization: Division of Digestive and General Surgery, Japanese Red Cross Nagaoka Hospital – sequence: 16 givenname: Tatsuo surname: Tani fullname: Tani, Tatsuo organization: Division of Digestive and General Surgery, Japanese Red Cross Nagaoka Hospital – sequence: 17 givenname: Hiroshi surname: Hirukawa fullname: Hirukawa, Hiroshi organization: Department of Surgery, Tachikawa General Hospital – sequence: 18 givenname: Tetsuya surname: Tada fullname: Tada, Tetsuya organization: Department of Surgery, Tachikawa General Hospital – sequence: 19 givenname: Yoshifumi surname: Shimada fullname: Shimada, Yoshifumi organization: Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences – sequence: 20 givenname: Jun surname: Sakata fullname: Sakata, Jun organization: Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences – sequence: 21 givenname: Toshifumi surname: Wakai fullname: Wakai, Toshifumi organization: Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
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Keywords	Gastric cancer Conversion surgery Stage IV
Language	English
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PublicationTitle	BMC surgery
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PublicationYear	2022
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Snippet	Background Recent improvements in systemic chemotherapy have provided an opportunity for patients with stage IV gastric cancer (GC) to undergo conversion... Recent improvements in systemic chemotherapy have provided an opportunity for patients with stage IV gastric cancer (GC) to undergo conversion surgery (CS).... Background Recent improvements in systemic chemotherapy have provided an opportunity for patients with stage IV gastric cancer (GC) to undergo conversion... Abstract Background Recent improvements in systemic chemotherapy have provided an opportunity for patients with stage IV gastric cancer (GC) to undergo...
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SubjectTerms	Aorta Cancer Chemotherapy Classification Conversion Conversion surgery Cytology Dissection Gastrectomy Gastric cancer Gastrointestinal surgery Humans Internal Medicine Liver Lymph nodes Lymphatic system Medical prognosis Medicine Medicine & Public Health Metastases Metastasis Multivariate analysis Neoplasm Staging Oncology, Experimental Patients Peritoneum Prognosis Retrospective Studies Stage IV Statistical analysis Stomach cancer Stomach Neoplasms - pathology Surgery Surgical outcomes Survival analysis Tomography
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Title	Conversion surgery for stage IV gastric cancer: a multicenter retrospective study
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