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Open AccessArticle

Stage IV Gastric Cancer: The Surgical Perspective of the Italian Research Group on Gastric Cancer

Clinica Chirurgica, Università di Brescia, 25100 Brescia, Italy
Chirurgia Generale, Università di Verona, 37100 Verona, Italy
Chirurgia Generale, Ospedale di Forlì, Università di Bologna, 47121 Forlì, Italy
Chirurgia Generale, Università di Torino, 10121 Torino, Italy
Chirurgia Generale, Università di Perugia, 06121 Perugia, Italy
Chirurgia Oncologica, Università di Siena, 53100 Siena, Italy
Chirurgia Generale, Ospedale di Arezzo, 52100 Arezzo, Italy
Author to whom correspondence should be addressed.
Cancers 2020, 12(1), 158;
Received: 28 October 2019 / Revised: 23 December 2019 / Accepted: 2 January 2020 / Published: 9 January 2020
Background/Aim: This work explored the prognostic role of curative versus non-curative surgery, the prognostic value of the various localizations of metastatic disease, and the possibility of identifying patients to be submitted to aggressive therapies. Patients and Methods: Retrospective chart review of stage IV patients operated on in our institutions. Results: Two hundred and eighty-two patients were considered; 73.4% had a single metastatic presentation. In 117 cases, a curative (R0) resection of primary and metastases was possible; 75 received a R1 resection and 90 a palliative R2 gastrectomy. Surgery was integrated with chemotherapy in multiple forms: conversion therapy, HIPEC, neo-adjuvant and adjuvant treatment. Median overall survival (OS) of the entire cohort was 10.9 months, with 14 months for the R0 subgroup. There was no correlation between metastasis site and survival. At multivariate analysis, several variables associated with the lymphatic sphere showed prognostic value, as well as tumor histology and the curativity of the surgical procedure, with a worse prognosis associated with a low number of resected nodes, D1 lymphectomy, pN3, non-intestinal histology, and R+ surgery. Considering the subgroup of R0 patients, the variables pT, pN and D displayed an independent prognostic role with a cumulative effect, showing that patients with no more than 1 risk factor can reach a median survival of 33 months. Conclusions: Our data show that the possibility of effective care also exists for Western patients with stage IV gastric cancer. View Full-Text
Keywords: gastric cancer; metastasis; surgery; moltimodal treatment; prognostic factors gastric cancer; metastasis; surgery; moltimodal treatment; prognostic factors
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Ministrini, S.; Bencivenga, M.; Solaini, L.; Cipollari, C.; Sofia, S.; Marino, E.; d’Ignazio, A.; Molteni, B.; Mura, G.; Marrelli, D.; Degiuli, M.; Donini, A.; Roviello, F.; de Manzoni, G.; Morgagni, P.; Tiberio, G.A.M. Stage IV Gastric Cancer: The Surgical Perspective of the Italian Research Group on Gastric Cancer. Cancers 2020, 12, 158.

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