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Ida et al. J Cancer Metastasis Treat 2018;4:22                      Journal of Cancer
               DOI: 10.20517/2394-4722.2017.75                           Metastasis and Treatment




               Review                                                                        Open Access


               Conversion surgery for stage IV gastric cancer


               Satoshi Ida, Masayuki Watanabe

               Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo 135-
               8550, Japan.

               Correspondence to: Dr. Satoshi Ida, Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese
               Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo 135-8550, Japan. E-mail: satoshi.ida@jfcr.or.jp
               How to cite this article: Ida S, Watanabe M. Conversion surgery for stage IV gastric cancer. J Cancer Metastasis Treat 2018;4:22.
               http://dx.doi.org/10.20517/2394-4722.2017.75
               Received: 21 Nov 2017    First Decision: 18 Jan 2018    Revised: 20 Apr 2018    Accepted: 23 Apr 2018    Published: 16 May 2018

               Science Editor: Lucio Miele    Copy Editor: Jun-Yao Li    Production Editor: Cai-Hong Wang


               Abstract
               Gastric cancer with distant metastases, such as para-aortic lymph node metastases, hepatic metastases, and peritoneal
               dissemination, is classified as stage IV. In this situation, cancer cells have formed micrometastases throughout the body;
               therefore, according to the algorithm of the Japanese guidelines, stage IV cancer is outside the indication for curative
               resection. Recent advances in some chemical agents have been remarkable, and some patients have survived for long
               periods even with stage IV gastric cancer. Thus, even in patients with stage IV gastric cancer, there is a possibility that
               gastrectomy as conversion surgery could play an important role in the treatment strategy. Gastrectomy as conversion
               therapy can be safely conducted without perioperative mortality and is considered a sufficiently acceptable treatment
               strategy. However, the significance of conversion surgery for stage IV gastric cancer remains controversial. In this
               review, we summarize the treatment strategies and outcomes of conversion surgery for stage IV gastric cancer.

               Keywords: Gastric cancer, stage IV, gastrectomy, conversion surgery, outcome




               INTRODUCTION
               Gastric cancer is a highly malignant tumor that can metastasize at high rates by lymphogenous spread,
               hematogenous spread, and dissemination. In stage IV advanced gastric cancer, which is characterized by
               distant metastasis to sites other than regional lymph nodes, cancer cells are considered to have formed
               micrometastases throughout the body. Such cancer is outside the indication for curative resection. As stated
               in the Japanese treatment guidelines, chemotherapy remains the main therapeutic approach for stage IV
               gastric cancer, and surgery for these patients is usually confined to palliative resection or a bypass operation to
               relieve symptoms . The European Society for Medical Oncology (ESMO)  and the National Comprehensive
                                                                            [2]
                              [1]
                           © 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,
                sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
                as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
                and indicate if changes were made.


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