Background and aim: We investigated the clinical benefits of salvage gastrectomy for stage IV gastric cancer patients whose distant lesions showed complete response after chemotherapy.
Methods: We enrolled 18 stage IV gastric cancer patients whose distant metastases had disappeared or were controlled by a combination of biweekly paclitaxel (PTX) and S-1. After chemotherapy, these patients received gastrectomy with lymph node dissection. The postoperative outcome was analyzed with respect to both the histological effects of chemotherapy and tumor behavior.
Results: Of the 18 patients, 8 had distant lymph node metastases, 9 had peritoneal dissemination, and five had multiple liver metastases prior to chemotherapy. Fourteen patients received curative surgery (R0). No severe postoperative complications were encountered. Pathological evaluation revealed grade 3 and grade 2 tumor regression in the primary lesion in one and five patients, respectively, and grade 3 and grade 2 tumor regression in the lymph nodes in one and six patients, respectively. Univariate analysis of the patients' prognosis identified R number, gross tumor type, histological grade of tumor regression, and gender as significant factors. Multivariate analysis showed that only the R number was an independent prognostic factor.
Conclusion: R0 salvage gastrectomy following a combination of biweekly PTX and S-1 may have significant clinical efficacy for advanced gastric cancer patients.