Oligometastatic Gastric Cancer: Novel Considerations for Personalized Approach.

Résumé

BACKGROUND: Metastatic disease traditionally classifies gastric cancer as stage M1, precluding surgical intervention and enrolling patients in palliative treatment protocols. This principle holds regardless of the number, the location, and the quantity of metastatic sites. "Oligometastatic disease" is an intermediate state between localized and widely spread gastric cancer.METHODS: Locoregional treatments may offer long survival or even cure in highly selected cases. There are no evidence-based guidelines for the appropriate management of this clinical entity. Tailored strategic techniques are required to incorporate surgical treatment, when applicable, into the management protocols of these patients. The surgical approach (following neoadjuvant treatment) aiming at R0 resection of neoplasms that are technically or oncologically unresectable, or only borderline resectable at initial evaluation is defined as "conversion therapy".RESULTS: The surgical approach aims at locoregional control of the disease, radical resection of all cancer sites, adequate lymph node cleansing and uncomplicated anastomosis. Disease progression is a clear indication of palliative treatment. In this article, we aim to provide an extensive literature search about current status of oligometastatic gastric disease multimodal treatment.CONCLUSIONS: Given the malignancy potential of gastric cancer, the decision for an operative approach should be made with strict criteria by experienced surgeons and rational oncologists.