[Value of reduction surgery for incurable advanced gastric cancer: Discussion based on REGATTA trial]

Over 30% of gastric cancers in China are at stage IV disease at the time of diagnosis which is incurable or unresectable. Reduction surgery refers to non-curative gastrectomy for reducing tumor burden in the absence of severe symptoms. The benefit of reduction gastrectomy for these patients is controversial. Most of the retrospective data support its necessity. However, the results of the Japanese REGATTA study showed that reduction gastrectomy could not bring any survival benefit to patients compared with chemotherapy alone, so the guideline of the Japanese Society of Gastric Cancer is strongly against reduction gastrectomy. Although the design of the REGATTA study is not perfect and the conclusion is challenged, it provides the highest level of evidence. Surgeons should abstain from prophylactic reduction gastrectomy in clinical setting. The strategy should be decided by MDT discussion.