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therapy, which is defined as surgical resection intending to achieve radical cure following chemotherapy
[27]
and/or radiotherapy . Several studies have reported positive outcomes from this treatment [28-32] , although
none of them evaluated conversion therapy for patients who underwent PD. As we previously demonstrated,
PD has a high morbidity and mortality, and its survival benefit appears to be limited. Therefore, neoadjuvant
chemotherapy and conversion therapy should be considered as an alternative treatment strategy for patients
requiring PD for curative resection.

CONCLUSIONS
Although there is currently no solid evidence that PD may be recommended for advanced gastric cancer
with pancreatic invasion when R0 resection is possible, but the high morbidity and mortality should be
considered. In addition, multidisciplinary treatment, such as neoadjuvant chemotherapy, is anticipated to
improve survival. Nevertheless, a large-scale multicenter cohort study is required to evaluate this highly
invasive procedure.

DECLARATIONS
Authors’ contributions
Designed the study, reviewed the literature, and wrote the manuscript: Makuuchi R
Contributed to writing the manuscript, drafting, critical revision, editing, and final approval of the final
version: Terashima M
Contributed to critical reversion of the manuscript and final approval of the final version: Irino T, Tanizawa Y,
Bando E, Kawamura T

Availability of data and materials
Not applicable.

Financial support and sponsorship
This study was supported in part by a scientific research grant for multi-institutional trials to establish a new
standard treatment for solid tumors in adults from the National Cancer Center Research and Development
Fund (29-A-3).

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2018.

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