Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
Surg Today. 2021 Nov;51(11):1736-1754. doi: 10.1007/s00595-020-02222-0. Epub 2021 Jan 23.
Palliative chemotherapy with best supportive care is a mainstay for patients with gastric cancer (GC) and distant metastasis. However, with advances in GC chemotherapy, multimodal treatment, including perioperative chemotherapy plus conversion surgery, has attracted attention as a new strategy to improve the outcome of patients with stage IV disease. Conversion surgery is defined as surgical treatment aimed at R0 resection after a good response to induction chemotherapy for tumors originally considered unresectable or marginally resectable for technical and/or oncological reasons. Various biological characteristics differ, depending on each metastatic condition in stage IV GC. The main metastatic pathways of GC can be divided into three categories: lymphatic, hematogenous, and peritoneal. In each category, considerable historical data on conversion surgery have demonstrated the benefits of individualized approaches. However, owing to the diversity of these conditions, a common definition, including the choice of induction chemotherapy, optimal timing of resection, and eligibility for conversion surgery, has not been established among surgical oncologists. Thus, we explore the current and future treatment options by reviewing the literature on this controversial topic comprehensively.
对于患有胃癌（GC）和远处转移的患者，最佳支持治疗的姑息性化疗是主要治疗方法。然而，随着 GC 化疗的进步，包括围手术期化疗加转化手术在内的多模式治疗已作为改善 IV 期疾病患者预后的新策略引起关注。转化手术定义为对最初因技术和/或肿瘤原因而被认为无法切除或勉强可切除的肿瘤，在诱导化疗后出现良好反应时进行的旨在达到 R0 切除的手术治疗。IV 期 GC 中每个转移性病变的各种生物学特征不同。GC 的主要转移途径可分为淋巴、血行和腹膜。在每种类别中，关于转化手术的大量历史数据都证明了个体化方法的益处。然而，由于这些情况的多样性，外科肿瘤学家之间尚未就包括诱导化疗选择、最佳切除时机和转化手术适应证在内的共同定义达成一致。因此，我们通过全面回顾关于这一有争议话题的文献，探讨当前和未来的治疗选择。
