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KMID : 1188520150110010001
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Korean Journal of Clinical Oncology
2015 Volume.11 No. 1 p.1 ~ p.5
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The role of surgery in stage IV gastric cancer
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Han Dong-Seok
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Abstract
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Surgery plays a key role in gastric cancer treatment without distant metastasis. However, once distant sites are involved, no optimal therapeutic strategy has been established. Because M1 gastric cancer is a heterogeneous disease entity according to the extent and site of metastasis, it is difficult to analyze and interpret the result of study subjected to relative small number of patients. In patients without symptoms, several studies have shown that reductive surgery might have a benefit in terms of survival and quality of life. A randomized controlled trial of reduction surgery plus chemotherapy versus chemotherapy alone for M1 gastric cancer is ongoing (REductive Gastrectomy for Advanced Tumor in Three Asian countries [REGATTA], JCOG0705/KGCA01), and the result would be reported in near future. Currently, as an initial treatment for M1 gastric cancer, chemotherapy is generally used in order to reduce tumor-related symptom and prolong survival. For patients responsive to chemotherapy, some retrospective studies reported that longer survival was observed in resection group after disappearing of distant metastasis. Recently, Japanese group reported that a multimodality treatment consisting of chemotherapy with S-1 and cisplatin followed by gastrectomy with D2+ para-aortic lymph node dissection was found to be promising for metastasis to the 16a1/b2 para-aortic lymph nodes.
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KEYWORD
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Gastric cancer, Metastasis, Surgery, Survival
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