[Conversion therapy of stage IV gastric cancer]

Patients with Stage IV gastric cancer are currently not considered operative candidates and are most often offered systemic chemotherapy. Recently, several novel regimens of combined chemotherapy have occasionally converted an initially unresectable gastric cancer to a resectable status. We evaluated the efficacy of surgical resection following the response to the primary chemotherapy for Stage IV gastric cancer.

The subjects were 30 advanced gastric cancer patients who were clinically diagnosed as resectable following their response to primary chemotherapy between 2002 and 2011.

Twenty patients underwent R0 resection. Two patients had a R1/2 resection, and 8 patients did not undergo surgical resection because of the presence of noncurable factors. The postoperative complication rate was high(41%), with a mortality rate of 0%. The median survival time(MST)of the patients who underwent R0 resection was 1, 409 days, and the MST of the patients who could not undergo R0 resction was 783 days(p=0. 0017).

Surgical resection following the response to primary chemotherapy might be effective for patients who underwent R0 resection, although it had a high postoperative complication rate. Staging laparoscopy may be useful for the evaluation of resectability after chemotherapy.