The prognostic factor and the optimal timing of conversion surgery in unresectable stage IV gastric cancer: A retrospective analysis.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 78-78
Author(s):  
Tamotsu Sagawa ◽  
Yutaka Okagawa ◽  
Fumito Tamura ◽  
Tsuyoshi Hayashi ◽  
Koshi Fujikawa ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Survival Rate ◽  
Univariate Analysis ◽  
Stage Iv ◽  
Residual Tumor ◽  
Optimal Timing ◽  
Conversion Surgery ◽  
Stage Iv Gastric Cancer ◽  
Metastatic Lesions ◽  
Unresectable Stage

78 Background: Conversion surgery could be an option for unresectable stage IV gastric cancer when distant metastasis (M1) is disappeared by chemotherapy. However, the indication and the optimal timing of conversion surgery in stage IV gastric cancer remain unclear, even if metastatic lesions disappear with chemotherapy. Guideline of National Comprehensive Cancer Network also shows no principle after down-staging. Methods: This retrospective study examined 34 gastric cancer patients who underwent curative conversion surgery at our institute between 2005 and 2014. Clinicopathologic characteristics and patient outcomes were analyzed, with particular focus on the potential to select patients who might benefit from surgical resection. Results: The number of M1 factors was one in 31 patients and two in 3, including metastases to non-regional lymph node in 21, peritoneum in 8, liver in 5, and lung in 3. The regimen of chemotherapy was Docetaxel/CDDP/S-1 in 23 patients, Docetaxel/CDDP/S-1+Trastuzmab in 6, S-1/CDDP in 2, Docetaxel/S-1 in 1, CPT/CDDP in 1, and S-1 monotherapy in 1. The median duration from initiation of chemotherapy to the operation was 114 days (range 37-653 days). Total gastrectomy was performed in 27 patients and distal gastrectomy was performed in 7 patients. Complete resection with no residual tumor (R0) was achieved in 23 of 34 patients, microscopic residual tumor status (R1) in 10, and macroscopic residual tumor (R2) in 1. The 3-year overall survival (OS) rate among the patients who underwent conversion therapy was 58.0% with MST of 1190 days. Univariate analysis among the patents with conversion surgery identified intestinal differentiation, pathological response grade≧1b, R0 resection as significant prognostic factors. Patients operated on more than 91 days from initiation of chemotherapy had the 3-year survival rate of 68.2%, compared to 40.0% for patients operated on less than 90 days. Conclusions: Our data demonstrate the increased 3-year survival rate associated with delayed conversion surgery for stage IV gastric cancer. Delayed conversion surgery should be considered for patients, even if metastatic lesions disappear with chemotherapy.

scholarly journals Conversion Surgery for Patients With Stage IV HER2-Positive Gastric Cancer: A Report of 3 Patients

2017 ◽  
Vol 102 (3-4) ◽  
pp. 137-140 ◽  
Author(s):  
Shin Saito ◽  
Yoshinori Hosoya ◽  
Hirofumi Fujii ◽  
Hideyuki Ohzawa ◽  
Akira Tanaka ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Targeted Therapy ◽  
Advanced Gastric Cancer ◽  
Molecular Targeted Therapy ◽  
Stage Iv ◽  
Complete Response ◽  
Conversion Surgery ◽  
Her2 Positive ◽  
Stage Iv Gastric Cancer ◽  
Metastatic Lesions

Gastric cancer is a common malignancy and remains potentially lethal. The prognosis of patients with stage IV gastric cancer is thought to be poor, but new molecular targeted therapy may benefit patients with advanced gastric cancer. Currently, conversion surgery after chemotherapy with a trastuzumab-containing regimen is reported to be effective in these patients. We present 3 patients with human epidermal growth factor receptor 2 (HER2)–positive advanced gastric cancer who underwent conversion surgery after receiving a trastuzumab-containing chemotherapy regimen. Interestingly, the primary lesion acquired resistance to the trastuzumab-containing regimen, although the metastatic lesions maintained a complete response. The reason why the primary lesions became resistant to trastuzumab remains unclear. More studies are needed to clarify the mechanism of resistance. Conversion surgery, made possible by the use of molecular-targeted therapy, may improve the prognosis of patients with stage IV gastric cancer, particularly if metastatic lesions show a complete response to therapy.

Conversion surgery of Stage IV gastric cancer with peritoneal dissemination after nivolumab

2021 ◽  
Author(s):  
Yuji Toyota ◽  
Kunio Okamoto ◽  
Norimitsu Tanaka ◽  
Hugh Shunsuke Colvin ◽  
Yuta Takahashi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Peritoneal Dissemination ◽  
Stage Iv ◽  
Conversion Surgery ◽  
Stage Iv Gastric Cancer

scholarly journals Prognostic benefit of conversion surgery for HER2 positive stage IV gastric cancer; a case series study of eleven patients treated with trastuzumab-based chemotherapy

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Koichi Hayano ◽  
Hiroki Watanabe ◽  
Takahiro Ryuzaki ◽  
Naoto Sawada ◽  
Gaku Ohira ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Stage Iv ◽  
R0 Resection ◽  
Conversion Surgery ◽  
First Line ◽  
Her2 Positive ◽  
Stage Iv Gastric Cancer ◽  
Gastric Cancer Patients ◽  
First Line Treatment

Abstract Background Since the ToGA trial, trastuzumab-based chemotherapy is the standard treatment for HER2 positive stage IV gastric cancer. However, it is not yet clear whether surgical resection after trastuzumab-based chemotherapy (conversion surgery) can improve survival of HER2 positive stage IV gastric cancer. The purpose of this study is to evaluate the prognostic benefit of conversion surgery in HER2 positive stage IV gastric cancer patients. Case presentation We retrospectively investigated the medical records of the patients with HER2 positive (IHC3(+) or IHC2(+)/FISH(+)) stage IV gastric cancer treated with trastuzumab-based chemotherapy as the first line treatment. Overall survival (OS) was compared between patients with conversion surgery and without. Eleven HER2 positive stage IV gastric cancer patients treated with trastuzumab-based chemotherapy as the first line treatment were evaluated. Response rate was 63.6%, and 6 of 11 patients could receive conversion surgery. R0 resection was achieved in four patients. In Kaplan–Meier analysis, patients who received conversion surgery showed significantly better OS than those without surgery (3-year survival rate, 66.7% vs. 20%, P = 0.03). The median OS of patients who achieved R0 resection is 51.8 months. Conclusions Conversion surgery might have a survival benefit for HER2 positive stage IV gastric cancer patients. If curative surgery is technically possible, conversion surgery could be a treatment option for HER2 positive stage IV gastric cancer.

The Clinical Significance of CA19-9 and Tumor Size Ratios for Predicting Prognosis After Conversion Surgery in Patients With Stage IV Gastric Cancer

2021 ◽  
Vol 41 (11) ◽  
pp. 5643-5649
Author(s):  
KEISHI OKUBO ◽  
TAKAAKI ARIGAMI ◽  
DAISUKE MATSUSHITA ◽  
YOSHIKAZU UENOSONO ◽  
SHIGEHIRO YANAGITA ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Clinical Significance ◽  
Tumor Size ◽  
Stage Iv ◽  
Conversion Surgery ◽  
Stage Iv Gastric Cancer

The efficacy of gastrectomy plus chemotherapy for stage IV gastric cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 132-132 ◽  
Author(s):  
Osamu Muto ◽  
Hitoshi Kotanagi
Keyword(s):  
Gastric Cancer ◽  
Statistical Analysis ◽  
Survival Rate ◽  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Single Agent ◽  
Stage Iv ◽  
Palliative Surgery ◽  
Stage Iv Gastric Cancer

132 Background: Metastatic gastric adenocarcinoma is an incurable condition. Despite the recently reported benefits of chemotherapies, the prognosis of advanced gastric cancer remains poor. The role of surgical resection is still debatable. Therefore, we investigated the efficacy of gastrectomy plus chemotherapy for stage IV gastric cancer. Methods: We retrospectively evaluated the efficacy of gastrectomy plus chemotherapy for treating stage IV gastric cancer. Among the 753 patients with gastric cancer treated with gastrectomy at our institute between 2003 and 2010, a total of 70 patients classified into stage IV and underwent gastrectomy with perioperative chemotherapy were included in this study. In the analysis, particular attention was paid to the prognostic factors of age, gender, tissue type, metastatic site, pre or postoperative chemotherapy, single agent or combination chemotherapy and the reason for gastrectomy (palliative surgery due to stenosis, bleeding or perforation and reduction surgery). The survival rate was calculated by the Kaplan Meier method and a statistical analysis was performed using the log-rank test. Survival was calculated from the beginning of the treatment until the last follow-up or death from any cause. Results: The median age was 65 years old. Peritoneal, lymph node and liver metastasis were 28, 23, and 13 patients respectively. Fifty-three patients had diffuse type. Gastrectomy followed by chemotherapy and chemotherapy were 53 patients. Single agent chemotherapy were 42 and combination were 28 patients. Thirty-one patients were underwent palliative surgery and 39 patients were reduction surgery. One-year survival rate of all patients was 43% and the median survival time was 19.9 months. In the statistical analysis, only reduction surgery plus chemotherapy demonstrated significant survival benefit. The median survival time was significantly greater in patients undergoing reduction gastrectomy group than in those undergoing palliative gastrectomy (25.3 versus 9.8 months; p=0.005). Conclusions: Long-term survival for patients with stage IV gastric cancer who are managed with reduction surgery and chemotherapy is achievable. Further study with a larger number of patients is warranted.

The feasibility and safety conversion surgery in stage IV gastric cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 164-164
Author(s):  
Tsutomu Sato ◽  
Ken Nishimura ◽  
Norisuke Nakayama ◽  
Osamu Motohashi ◽  
Kenki Segami ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Median Duration ◽  
Regional Lymph Node ◽  
Stage Iv ◽  
Operation Time ◽  
Conversion Surgery ◽  
Period Range ◽  
Stage Iv Gastric Cancer ◽  
Nodal Dissection

164 Background: Conversion surgery could be an option for stage IV gastric cancer when distant metastasis (M1) is disappeared by palliative chemotherapy, however, feasibility, safety and efficacy of surgery after long-term chemotherapy remains unclear. Methods: This retrospective study examined 21 gastric cancer patients who underwent curative conversion surgery between 2001 and 2013. Postoperative complications were evaluated according to the Clavien-Dindo classification. Overall survival (OS) was estimated by Kaplan-Meier method. Results: Median follow-up period (range) was 43.9 months (7.2-72.1 months). The number of M1 factors was one in 17 patients and two in 4, including metastases to non-regional lymph node in 11, peritoneum in 11, and liver in 3. The regimen of chemotherapy was S-1/CDDP in 11 patients, S-1/docetaxel/CDDP in 5, S-1/docetaxel in 2, 5FU/leucovorin/paclitaxel in 1, CPT/CDDP in 1, and S-1 monotherapy in 1. The median duration from initiation of chemotherapy to disappearance of M1 factor was 3.5 months and the median duration from initiation of chemotherapy to the operation was 7.5 months. A total of 19 patients (90.4%) underwent over D2 lymphadenectomy including modified D2 in 2 patients, D2 in 16, and D2 plus para-aortic nodal dissection in 3. M1 tumor was not resected except para-aortic nodal dissection in 3 patients. The median operation time and bleeding were 205 minutes and 228 ml, respectively. Grade 2/3/4 morbidities were observed in 5 patients (23.8%); 2 pancreatic fistula (grade 2), 2 abdominal abscess (grade 2 and 3), and 1 anastomotic leakage (grade 3). No mortality was observed. Pathological response of the primary tumor, defined as disappearance of more than two third of the tumor cells, was 66.7% including 19.0% of complete response. The overall survival (OS) after initiation of chemotherapy was 90.5% at 1-year, 85.7% at 2-year, and 75.9% at 3-year with median survival time (MST) of 52.9 months, while OS after surgery was 90.5% at 1 year, 76.2% at 2-year, and 64.5% at 3-year with MST of 40.9 months. Conclusions: Curative conversion gastrectomy for stage IV gastric cancer was feasible and safe. Considering excellent survival, conversion surgery has a value to be evaluated in prospective studies.

scholarly journals Conversion Surgery for Stage IV Gastric Cancer

2019 ◽  
Vol 9 ◽  
Author(s):  
Fei Zhang ◽  
Xuanzhang Huang ◽  
Yongxi Song ◽  
Peng Gao ◽  
Cen Zhou ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Stage Iv ◽  
Conversion Surgery ◽  
Stage Iv Gastric Cancer
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