In the traditional understanding of gastric cancer, surgical resection is only applied to early or locally advanced gastric cancer, and in metastatic gastric cancer, surgery is considered to be "no way" - such as tumor blockage of the digestive tract, obstruction before "forced" use (also known as "palliative surgery") ...
In a 2006 study in the United States, it was found that a subset of patients with metastatic gastric cancer (especially those with a single metastatic site, a small number of metastases, and no obvious tumors in the body after surgery) had a longer survival time (16.3 months vs. 5.9 months) than those who did not have surgery.
Doctors recognized the feasibility of surgery in patients with advanced metastatic gastric cancer and came up with the concept of a "single distant metastasis" of gastric cancer.
First, what is the "single distant metastasis" of gastric cancer?
"Single distant metastasis" refers to: distant metastasis other than gastric primary lesions and regional lymph nodes, with the possibility of local treatment in technology.
It can be seen that "single" does not mean a metastase, usually one or more metastases that can be completely eliminated by local treatment.
The main treatment modalities for advanced gastric cancer with single distant metastasis are preoperative chemotherapy (neoadjuvant chemotherapy) → radical surgical treatment (gastric and/or metastatic foci) → postoperative adjuvant chemotherapy. The famous Lancet in 2016 proposed that this treatment model increased the 3-year survival rate of patients from 2.8% to 24.1%.
Depending on when the metastases are found, "single distant metastases" are divided into:
Simultaneous single metastases: single distant metastases that occur before and during gastric cancer, and there are problems with primary lesions and metastatic lesion resection.
Heterochronic single metastases: a single distant metastasis that occurs six months after gastric cancer surgery, and there is no primary focus resection problem.
Overall, the prognosis of heterochral unitary transfer is generally better than that of simultane single transfer.
Second, how to treat the "single distant metastasis" of gastric cancer?
1. Single abdominal para-aortic lymph node metastasis
The para-abdominal aortic lymph nodes are classified as "distant metastases" because they are far from the lymph nodes in the gastric cancer area.
According to statistics, the probability of metastasis of abdominal paraortic lymph nodes in advanced gastric cancer is between 10% and 30%, and simultaneous metastasis is more common.
A study by Zhongshan Hospital Affiliated to Fudan University shows that neoadjuvant chemotherapy combined with radical surgery can bring an average of 18.1 months of tumor-free survival to these patients.
The preferred regimen for neoadjuvant chemotherapy is tigios thio plus cisplatin chemotherapy, with an effective rate of 64.7%, a complete surgical resection rate of 82%, a 3-year survival rate of 58.8%, and a 5-year survival rate of 53%.
The scope of radical surgery includes gastric primary lesions and regional lymph nodes. As for whether the para-abdominal aortic lymph nodes are incised, there is still controversy.
Studies have shown that in the elderly, patients with more than 3 abdominal paraortic lymph node metastases and a gastric primary lesion diameter greater than 12 cm, abdominal paraortic lymph node resection does not allow patients to live longer...
2. Single liver metastases
The incidence of liver metastasis in advanced gastric cancer is 4%-14%, and the survival rate after liver metastasis is only 7%, which is divided into simultaneous and epochal single liver metastases.
The "2020 Chinese Society of Clinical Oncology Gastric Cancer Diagnosis and Treatment Guidelines" believes that "local treatment of gastric cancer single liver metastases" refers to: liver single metastases ≤ 5 cm in diameter, or several metastases on a liver lobe, and did not invade blood vessels, bile ducts.
Such patients can achieve better efficacy by "neoadjuvant chemotherapy→ radical resection of gastric and/or hepatic metastases→ postoperative adjuvant therapy model. Studies have shown that the small primary lesion of the stomach, the low preoperative tumor marker CEA/CA199, the clean cut of surgery, and the standardized treatment after surgery are the prerequisites for the good effect of this treatment model.
In patients with simultaneous single liver metastases, radical resection of gastric + hepatic metastases was performed, and survival was extended by 16.1 months. In heterochral single liver metastases, resection of hepatic metastases also prolonged survival by about 19 months.
For patients whose single liver metastases are not suitable for radical surgery (such as old age, surgical contraindications, etc.), radiofrequency ablation, microwave ablation, intervention, radiotherapy and other means can be used to eliminate liver metastases.
Studies have shown that after chemotherapy combined with radiofrequency ablation, the average survival time of patients with simultaneous single liver metastasis can reach 23 months, and the average survival time of heterochronic single liver metastases is 25 months.
3. Single ovarian metastasis
This is the infamous "Keukenburg tumor", which occurs in about 3%-5%, with premenopausal women aged 40-50 accounting for the majority. The average survival time is only 7-14 months.
Simultaneous mono-ovarian metastases, currently treated with systemic chemotherapy.
Studies have shown that neoadjuvant chemotherapy plus radical resection can increase the average survival time to 19-23.7 months. However, if the pathological type is incinerated cell carcinoma, or is it mainly based on systemic chemotherapy.
Heterochral single ovarian metastasis, oophorectomy combined with pharmacotherapy is an important means.
Studies have shown that heterochral ovarian transfers perform ovarian resection better than simultaneous ovarian metastases, with survival times of 17 months and 36 months, respectively.
Written at the end of the article
Cancer is unfortunate, but fortunately, we live in an era of rapid medical development.
This rapid development is not only reflected in the means of examination and treatment, but also in people's health awareness, the way to obtain medical information, the convenience of medical treatment, etc. We firmly believe that more and more cancer patients will get better treatment!
"Send a message to the end of the world, light cold bottom with sorrow, spring breeze is not far away, only in the east of the house", with you all!