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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
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