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World J Gastrointest Oncol. Feb 15, 2022; 14(2): 434-449
Published online Feb 15, 2022. doi: 10.4251/wjgo.v14.i2.434
Multimodal treatment in oligometastatic gastric cancer
Mickael Chevallay, Charles-Henri Wassmer, Pouya Iranmanesh, Minoa K Jung, Stefan P Mönig
Mickael Chevallay, Charles-Henri Wassmer, Pouya Iranmanesh, Minoa K Jung, Stefan P Mönig, Division of Digestive Surgery, Geneva University Hospital and Faculty of Medicine, Geneva 1205, Genève, Switzerland
Author contributions: Chevallay M designed the manuscript structure; Chevallay M and Wassmer CH performed the research; Chevallay M, Wassmer CH, Iranmanesh P, Jung MK and Mönig SP analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Stefan P Mönig, MD, Surgeon, Division of Visceral Surgery, Department of Surgery, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Genève, Switzerland. stefan.moenig@hcuge.ch
Received: May 10, 2021
Peer-review started: May 10, 2021
First decision: June 16, 2021
Revised: August 2, 2021
Accepted: December 28, 2021
Article in press: December 28, 2021
Published online: February 15, 2022
Processing time: 275 Days and 20.7 Hours
Abstract

Gastric cancer is generally diagnosed at an advanced stage, especially in countries without screening programs. Previously, the metastatic stage was synonymous with palliative management, and surgical indications were only for symptomatic relief. However, this therapeutic option is associated with poor prognosis. A subgroup of patients with limited metastatic disease could benefit from intensive treatment. A combination of chemotherapy, immunotherapy, and targeted therapy could help either maintain a resectable state for oligometastatic disease or diminish the metastasis size to obtain a complete resection configuration. This latter strategy is known as conversion therapy and has growing evidence with favorable outcomes. Oncosurgical approach of metastatic disease could prolong survival in selected patients. The challenge for the surgeon and oncologist is to identify these specific patients to offer the best multimodal management. We review in this article the actual evidence for the treatment of oligometastatic gastric cancer with curative intent.

Keywords: Gastric cancer; Radiotherapy; Chemotherapy; Multimodal treatment; Oligometastatis; Immunotherapy

Core Tip: Oligometastatic gastric cancer is an increasingly recognized clinical entity characterized by limited metastatic spread. With the development of multimodal treatment, curative treatment with complete surgical resection can be achieved. In our review, we have shown evidence that chemotherapy, immunotherapy, and targeted therapy could control the expansion of the tumor or decrease the size of the metastasis to achieve a resectable configuration. Surgery is not only a palliative option for metastatic disease but could be offered with curative intent in selected patients.