Outcomes of minimally invasive conversion surgery after immune checkpoint inhibitors for stage IV gastric cancer.

INTRODUCTION

Conversion surgery, enabling curative resection in initially unresectable tumors post-chemotherapy, has gained traction across various cancers. In gastric cancer, particularly HER2-negative cStage IV, integrating immune checkpoint inhibitors (ICIs) like nivolumab with chemotherapy presents a promising strategy. This study evaluates the efficacy and safety of minimally invasive conversion surgery following ICI-combined chemotherapy for these patients.

MATERIALS AND

METHODS

Patients with HER2-negative cStage IV gastric cancer treated at our institution (2022-2024) were retrospectively reviewed. Diagnosis involved contrast-enhanced CT and staging laparoscopy. Treatment options included SOX + Nivo or FOLFOX + Nivo regimens for eligible candidates aged 20-80 years. Conversion surgery eligibility was assessed after initial and additional treatment cycles, guided by established diagnostic and re-staging criteria. Minimally invasive surgical techniques were applied unless contraindicated.

RESULTS

Of 42 patients, 28 were cStage IV, with 18 HER2-negative. Conversion surgery was successful in 14 cases; 12 employed minimally invasive methods. The cohort comprised mainly males with a median age of 70. Post-treatment analysis showed significant improvements in performance status and nutritional markers. Grade 2 postoperative complications were minimal, with no severe events. The median postoperative hospital stay was nine days, and high rates of tumor response were observed. The 1-year relapse-free survival and 1-year overall survival were both 100.0%

CONCLUSION

The study underscores the potential of ICI-combined chemotherapy to achieve control of metastatic disease and enable minimally invasive curative surgery in stage IV gastric cancer, thereby offering improved prognosis for this patient cohort. Further research is advocated to confirm long-term survival benefits.