Universidade Federal do Pará, Oncology Research Center - Belém (PA), Brazil.
Universidade Federal do Pará, João de Barros Barreto University Hospital, General Surgery and Digestive Tract Service - Belém (PA), Brazil.
Arq Bras Cir Dig. 2023 Sep 15;36:e1752. doi: 10.1590/0102-672020230034e1752. eCollection 2023.
Metastatic gastric cancer traditionally hinders surgical treatment options, confining them to palliative procedures. The presence of metastases in these tumors is classified as M1, irrespective of their characteristics, quantity, or location. However, oligometastatic disease emerged as an intermediate state between localized and widely disseminated cancer. It exhibits diverse patterns based on metastatic disease extent, type, and location. Adequately addressing this distinctive metastatic state necessitates tailored strategies that surpass the realm of palliative care. Differentprimary tumor types present discernible scenarios of oligometastatic disease, including preferred sites of occurrence and chronological progression. Due to the novelty of this theme and the heterogeneity of the disease, uncertainties still exist, and the ability to provide confident guidelines is challenging. Currently, there are no effective predictors to determine the response and provide clear indications for surgical interventions and systemic treatments in oligometastatic disease. Treatment decisions are commonly based on apparent disease control by systemic therapies, with a short observation period and imaging assessments. Nonetheless, the inherent risk of misinterpretation remains a constant concern. The emergence of novel technologies and therapeutic modalities, such as immunotherapy, cellular therapy, and adoptive therapies, holds the potential to reshape the landscape of surgical treatment for the oligometastatic disease in gastric cancer, expanding the surgeon's role in this multidisciplinary approach. Prospective tools for patient selection in oligometastatic gastric cancer are being explored. Using non-invasive, cost-effective, widely available imaging techniques that provide real-time information may revolutionize medical practice, ensuring precision medicine accessibility, even in resource-constrained small healthcare facilities. Incorporating molecular classifications, liquid biopsies, and radiomic analysis in a complementary protocol will augment patient selection precision for surgical intervention in oligometastasis. Hopefully, these advancements will render surgeries unnecessary in many cases by providing highly effective alternative treatments.
转移性胃癌传统上阻碍了手术治疗选择，使其仅限于姑息性手术。这些肿瘤中的转移存在被归类为 M1，无论其特征、数量或位置如何。然而，寡转移疾病作为局限性和广泛传播性癌症之间的中间状态出现。它根据转移性疾病的范围、类型和位置表现出不同的模式。充分解决这种独特的转移状态需要超越姑息治疗的定制策略。不同的原发肿瘤类型表现出不同的寡转移疾病模式，包括易发生部位和时间进程。由于这个主题的新颖性和疾病的异质性，仍然存在不确定性，提供有信心的指南具有挑战性。目前，没有有效的预测指标来确定寡转移疾病的反应，并提供手术干预和系统治疗的明确指征。治疗决策通常基于系统治疗的明显疾病控制，观察期短，影像学评估。然而，存在错误解释的固有风险仍然是一个持续存在的问题。免疫疗法、细胞疗法和过继性疗法等新型技术和治疗方式的出现，有可能改变胃癌寡转移疾病的手术治疗格局，扩大外科医生在这种多学科方法中的作用。正在探索寡转移性胃癌患者选择的前瞻性工具。使用非侵入性、具有成本效益、广泛可用且提供实时信息的成像技术可能会彻底改变医疗实践，确保即使在资源有限的小型医疗机构中也能获得精准医学。将分子分类、液体活检和放射组学分析纳入补充方案将提高寡转移患者选择手术干预的精确性。希望这些进展能够通过提供高度有效的替代治疗方法，使许多情况下的手术变得不必要。
