Role of surgery in metastatic gastric cancer

Gastric cancer is frequently diagnosed at an advanced stage, leading to a poor overall prognosis, particularly in regions without population-based screening. Stage IV disease, defined by distant metastases, is associated with dismal survival outcomes. Current management is primarily palliative, consisting of systemic therapy-chemotherapy, immunotherapy, or targeted agents tailored to molecular biomarkers. Despite the recent therapeutic advances, durable survival remains rare. In selected patients with limited metastatic disease, surgical resection has emerged as a potential therapeutic strategy, with reports of favorable oncological outcomes. Several international guidelines and consensus statements now acknowledge surgery as an option in patients who demonstrate stable disease after a period of systemic therapy. The central challenge is the accurate identification of patients most likely to benefit from surgical intervention and the precise delineation of low-volume metastatic disease. This review synthesizes the available evidence on the role of surgery in the management of metastatic gastric cancer.