Conversion surgery for gastric cancer: A cohort study from a western center. (May 2018)

• Record Type: Journal Article
• Authors: Morgagni, Paolo; Solaini, Leonardo; Framarini, Massimo; Vittimberga, Giovanni; Gardini, Andrea; Tringali, Domenico; Valgiusti, Martina; Monti, Manlio; Ercolani, Giorgio
• Is Part Of: International journal of surgery. Volume 53(2018)
• Page Start: 360
• Page End: 365
• Publication Date: 2018-05
• Subjects: Unresectable gastric cancer -- Conversion surgery -- Induction chemotherapy -- Gastrectomy; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2018.04.016
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Background: Advanced unresectable gastric cancer has a dismal prognosis. The aim of this study was to evaluate the short- and long-term outcomes of patients who underwent induction chemotherapy ± gastrectomy for advanced gastric cancer. Material and methods: All patients referred to our center with a clinical diagnosis of unresectable locally advanced or stage IV gastric adenocarcinoma between April 2005 and August 2016 were included in the study. Cox regression was performed to find independent prognostic factor among the considered variable. Results: The cohort included 73 patients: 16 had best supportive care, 35 chemotherapy alone and 22 chemotherapy plus radical surgery. Thirty-three patients underwent surgery after chemotherapy. Twenty-two patients had R0 surgery, while the remaining 11 had only an exploratory procedure. Nine patients (40.9%) underwent gastrectomy plus hyperthermic intraperitoneal chemotherapy. Three patients out of 22 developed postoperative complications with a Clavien-Dindo grade above 2. Median survival was 50 months for patients who had chemotherapy plus surgery while it was 14 and 3 for those who had chemotherapy alone and best supportive care, respectively (p < 0.0001). Cox regression analysis performed on the whole cohort identified only radical conversion surgery as an independent factor positively associated with survival (HR 0.12, 95% CI 0.05–0.29, p < 0.0001). Conclusion: Conversion gastrectomy, when R0 could be achieved, is associated with long survivals and it is the most important prognostic factor in patients with advanced gastric cancer. Further studies are needed to define the ideal patient who can really benefit from this treatment. Highlights: Unresectable gastric cancer could be associated with a dismal prognosis. Chemotherapy has offered new perspectives for these patients. Conversion surgery may offer good survivals after palliative chemotherapy. Surgery should not be excluded a priori in advanced cases.