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Pergolini et al. J Cancer Metastasis Treat 2018;4:33 Journal of Cancer
DOI: 10.20517/2394-4722.2017.84 Metastasis and Treatment

Systematic Review Open Access

Surgical treatment of stage IV gastric cancer: is it
worthwhile?

Ilaria Pergolini , Paolo Ciano , Gianluca Guercioni , Marco Catarci 1
1,2
1,3
1
1 Department of Surgery, Ospedale “C. e G. Mazzoni”, AV5-ASUR Marche, Ascoli Piceno 63100, Italy.
2 Department of Surgery, Universita’ Politecnica delle Marche, Ancona 60030, Italy.
3 Department of Surgery, Università Tor Vergata, Rome 00133, Italy.
Correspondence to: Dr. Marco Catarci, Department of Surgery, Ospedale “C. e G. Mazzoni”, AV5-ASUR Marche, Ascoli Piceno
63100, Italy. E-mail: marcocatarci@gmail.com
How to cite this article: Pergolini I, Ciano P, Guercioni G, Catarci M. Surgical treatment of stage IV gastric cancer: is it
worthwhile? J Cancer Metastasis Treat 2018;4:33. http://dx.doi.org/10.20517/2394-4722.2017.84
Received: 29 Dec 2017 First Decision: 18 Jan 2018 Revised: 7 Feb 2018 Accepted: 20 Feb 2018 Published: 17 Jul 2018
Science Editor: Masayuki Watanabe Copy Editor: Jun-Yao Li Production Editor: Cai-Hong Wang

Abstract
Aim: To analyze clinical features and survival outcomes of patients with surgically-treated stage IV gastric cancer, in order
to evaluate the suitability of surgery in these patients.

Methods: We performed a systematic literature search using PubMed, MEDLINE, and Embase on October 9th, 2017.
Survival outcomes data were collected.

Results: The original search returned 2434 papers. Thirty-nine studies were included in the final review, of which 26
evaluated liver metastasis resection, four pulmonary metastasis resections and nine palliative gastrectomies. In total 933
patients underwent hepatectomy for liver metastasis from gastric cancer and median survival rates were 73%, 37% and
27% at 1-, 3- and 5-year respectively, with a median overall survival of 22 months (9-52 months). Data regarding resection
of lung metastases were scarce and extremely heterogeneous. In total 1115 patients underwent palliative gastrectomy
and median overall survival of patients was 12 months (8-53 months). In the only randomized controlled trial, no survival
benefit of additional gastrectomy over chemotherapy alone was found, in contrast with the retrospective studies.

Conclusion: Survival benefit of surgery in advanced gastric cancer is still unclear. Surgery may play an important role in
highly selected patients. However, further randomized controlled trials are necessary to clarify the actual impact of surgery
in these patients.

Keywords: Gastric cancer, metastasis, surgical treatment

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
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