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Outcomes of Conversion Surgery vs Conventional Systemic Therapy in Stage IV Gastric Cancer: A Systematic Review and
Kai Siang Chan1,2, Liyang Xiao3, Aung Myint Oo4,5
1Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. kchan023@e.ntu.edu.sg.
Journal of Gastrointestinal Cancer
|July 22, 2025
Summary
Conversion surgery (CS) after systemic treatment significantly improves survival for stage IV gastric cancer (GC) patients compared to no surgery. However, evidence quality is low due to study design limitations.
Area of Science:
- Oncology
- Surgical Oncology
- Gastrointestinal Oncology
Background:
- Stage IV gastric cancer (GC) carries a poor prognosis.
- Limited high-quality evidence exists on the role of conversion surgery (CS) in advanced GC.
- Systemic treatment is the standard, but its efficacy can be enhanced by surgical intervention in select cases.
Purpose of the Study:
- To compare long-term survival and morbidity between conversion surgery (CS) and no CS in stage IV GC patients.
- To evaluate the impact of systemic treatment followed by CS versus systemic treatment alone on patient outcomes.
- To synthesize existing evidence on the efficacy and safety of CS in advanced gastric cancer.
Main Methods:
- Systematic literature search of PubMed, Embase, Scopus, and Cochrane Library up to September 2024.
- Inclusion of studies involving stage IV GC patients receiving systemic chemotherapy +/- immunotherapy/other adjunct therapies.
- Pooled hazard ratio (HR) analysis for overall survival (OS) and progression-free survival (PFS), with subgroup analyses.
Main Results:
- 36 studies with 3177 patients (1273 CS, 1904 no CS) were included.
- Conversion surgery (CS) demonstrated superior pooled OS (HR 0.36) and PFS (HR 0.38) compared to no CS.
- Post-operative complication rates for CS were: anastomotic leak 5.4%, intra-abdominal abscess 3.6%, and post-operative bleeding 2.0%.
Conclusions:
- Conversion surgery (CS) following systemic treatment is associated with superior survival in stage IV GC.
- The quality of evidence is low, primarily due to the predominance of retrospective studies and heterogeneous patient selection criteria for CS.
- Further high-quality research, including randomized controlled trials, is needed to confirm these findings and optimize patient selection for CS.
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