Efficacy of surgery after successful chemotherapy for advanced gastric cancer

Background We evaluated the efficacy of surgical resection after successful chemotherapies in patients with advanced gastric cancer. Methods Eighteen surgical patients who had had successful chemotherapies were selected after a review of 218 case records. Results The 18 patients were grouped by their pretreatment status: 8 patients with distant lymph node metastases (N4 group), 7 with a small amount of ascites (P group), and 3 with both factors (N4+P group). Good responses were achieved in all of the 11 patients with node metastases, including 4 patients with a complete response. Ascites in 7 of 10 patients disappeared. Two of 18 patients (11%) achieved curability A resections, while 8 patients (44%) achieved curability B and 8 (44%) achieved curability C resections. Pathologic complete responses were documented in 2 patients of the N4 group. The median survival time of the 18 patients was 14 months, with a 1-year survival rate of 61%. Six patients have survived more than 2 years, and 3 more than 5 years to date. The 8 N4-group patients who had surgery showed significantly better survival than 19 similar patients who had distant metastases and responded to chemotherapy but did not have surgery. A similar comparison of the P-group patients found no significant difference in survival associated with surgery. Conclusions Surgery after chemotherapy might be beneficial for patients with distant lymph node metastases, but not effective for those with peritoneal dissemination.