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Pergolini et al. J Cancer Metastasis Treat 2018;4:33 I http://dx.doi.org/10.20517/2394-4722.2017.84 Page 9 of 11

these patients, even though the chemotherapy regimen used in the REGATTA trial was based on S-1, which
shows reduced tolerability in Western patients .
[63]

In summary, from the present literature, a surgical approach for stage IV gastric cancer shows uncertain
survival benefits and is not justified in all patients. Further randomized controlled trials are necessary to
clarify the actual impact of surgery in these patients. Probably, surgery may play an important role in highly
selected patients. Criteria to select patients who can benefit more from surgical treatment have not yet been
identified, and this needs further investigation.

DECLARATIONS
Acknowledgments
We would like to thank Dr. Robin Vasan from Department of Surgery, Massachusetts General Hospital,
Harvard Medical School for language editing.

Authors’ contributions
Concept, design, definition of intellectual content: Pergolini I, Ciano P, Guercioni G, Catarci M
Literature search, data acquisition, data analysis, statistical analysis: Pergolini I, Ciano P
Manuscript preparation: Pergolini I, Catarci M
Manuscript editing, manuscript review: Pergolini I, Ciano P, Guercioni G, Catarci M

Availability of data and materials
Data are searched and available from PubMed, MEDLINE, Embase.

Financial support and sponsorship
None.

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.

REFERENCES
1. Blot WJ, Devesa SS, Kneller RW FJJ. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 1991;265:1287-9.
2. Siegel R, Miller K, Jemal A. Cancer statistics , 2017. CA Cancer J Clin 2017;67:7-30.
3. National Cancer Institute - Surveillance, Epidemiology, and End Results Program. SEER*Stat Databases: November 2015 Submission.
Available from: https://seer.cancer.gov/data/seerstat/nov2015/ [Last accessed on 27 Feb 2018].
4. Shin A, Kim J, Park S. Gastric cancer epidemiology in Korea. J Gastric Cancer 2011;11:135-40.
5. Kemp CD, Kitano M, Kerkar S, Ripley RT, Marquardt JU, Schrump DS, Avital I. Pulmonary resection for metastatic gastric
cancer. J Thorac Oncol 2010;5:1796-805.
6. Spolverato G, Ejaz A, Kim Y, Squires MH, Poultsides GA, Fields RC, Schmidt C, Weber SM, Votanopoulos K, Maithel SK, Pawlik TM.
Rates and patterns of recurrence after curative intent resection for gastric cancer: a United States multi-institutional analysis. J Am Coll
Surg 2014;219:664-75.
7. Deng J, Liang H, Wang D, Sun D, Pan Y, Liu Y. Investigation of the recurrence patterns of gastric cancer following a curative resection.