Comparison of minimally invasive surgery and open surgery following chemotherapy for cStage IVb gastric cancer: a multicenter retrospective cohort study - Report - MDSpire

Evaluation of Minimally Invasive versus Open Surgical Approaches after Chemotherapy in Patients with Stage IVb Gastric Cancer: A Multicenter Retrospective Analysis

  • By

  • Yusuke Fujii

  • Shigeo Hisamori

  • Nobuaki Hoshino

  • Seiichiro Kanaya

  • Eiji Tanaka

  • Yoshito Yamashita

  • Akira Miki

  • Kosuke Toda

  • Michihiro Yamamoto

  • Yosuke Kinjo

  • Dai Manaka

  • Hiroaki Hata

  • Hironori Kawada

  • Shotaro Matsuda

  • Atsushi Itami

  • Kyoichi Hashimoto

  • Kenjiro Hirai

  • Sanae Nakajima

  • Hiroshi Okabe

  • Masazumi Sakaguchi

  • Yuichiro Kawamura

  • Takashi Sakamoto

  • Shintaro Okumura

  • Tatsuto Nishigori

  • Shigeru Tsunoda

  • Kazutaka Obama

  • July 20, 2026

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Evaluation of Minimally Invasive versus Open Surgical Approaches after Chemotherapy in Patients with Stage IVb Gastric Cancer

Overview

This multicenter retrospective study compares perioperative and survival outcomes between minimally invasive surgery (MIS) and open surgery in patients with stage IVb gastric cancer who underwent curative-intent gastrectomy after chemotherapy.

Background

Stage IV gastric cancer has a poor prognosis despite advances in systemic therapy, with median overall survival extending to 17–18 months. Conversion surgery following chemotherapy-induced tumor regression presents a potential treatment option, yet its technical challenges and the comparative effectiveness of surgical approaches remain unclear.

Data Highlights

No numerical data was provided in the source material.

Key Findings

  • Conversion surgery may offer a potential treatment option for select patients with stage IV gastric cancer.
  • Technical challenges of conversion surgery include chemotherapy-induced fibrosis that complicates normal tissue planes.
  • Minimally invasive surgery (MIS) is proposed to reduce physiologic stress and improve surgical outcomes.
  • Evidence for MIS in conversion surgery settings is currently fragmented and lacks robust comparative studies.
  • Ongoing trials, such as JCOG2301, aim to evaluate the survival impact of conversion surgery.

Clinical Implications

Clinicians should consider the technical challenges associated with conversion surgery when determining treatment plans for patients.

Conclusion

This study highlights the need for comparing surgical approaches in stage IV gastric cancer.

Related Resources & Content

  1. Gastric Cancer — Comparison of Open and Minimally Invasive Total Gastrectomy Following Neoadjuvant Chemotherapy: Findings from a European Randomized Study
  2. Journal of Gastrointestinal Surgery — Outcomes of Gastric Cancer Surgery in a Medium-Volume Center: A Study on the Use of Multimodal Therapy and Minimally Invasive Techniques
  3. Surgical Endoscopy — Impact of Laparoscopic Gastrectomy on Peritoneal Recurrence Rates in Borrmann Type IV Gastric Cancer: A Retrospective Cohort Analysis Utilizing Propensity Score Matching
  4. Surgical Endoscopy — Three-Year Outcomes and Lymph Node Metastasis Patterns in Gastric Cancer After Neoadjuvant Chemotherapy: Findings from a European Randomized Study
  5. ESMO Upper GI Pocket Guideline
  6. NCCN Guidelines for Patients
  7. Consensus guideline for the management of gastric cancer with synchronous peritoneal metastases
  8. ECRI Guidelines Trust® - Gastric cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up.
  9. https://jgc-online.org/pdf/10.5230/jgc.2026.26.e8
  10. Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trial - PubMed
  11. Effect of chemotherapy/targeted therapy alone vs. chemotherapy/targeted therapy followed by radical surgical resection on survival and quality of life in patients with limited-metastatic adenocarcinoma of the stomach or esophagogastric junction: The IKF-575/RENAISSANCE phase III trial. | Journal of Clinical Oncology
  12. A randomized controlled trial comparing conversion surgery with palliative chemotherapy in patients with initially unresectable cStage IVB/pStage IV advanced gastric cancer who presented remarkable response to chemotherapy: JCOG2301 (Conversion study). | Journal of Clinical Oncology
  13. https://www.jgc-online.org/pdf/10.5230/jgc.2025.25.e9
  14. BMC Cancer Tuohuti et al. BMC Cancer (2025
  15. Perioperative Outcomes in Open Versus Minimally Invasive Gastrectomy For Gastric Cancer: A European Multicenter Study Based on the GASTRODATA Registry - PubMed

Original Source(s)

Comparison of minimally invasive surgery and open surgery following chemotherapy for cStage IVb gastric cancer: a multicenter retrospective cohort study

  • by Yusuke Fujii, Shigeo Hisamori, Nobuaki Hoshino, Seiichiro Kanaya, Eiji Tanaka, Yoshito Yamashita, Akira Miki, Kosuke Toda, Michihiro Yamamoto, Yosuke Kinjo, Dai Manaka, Hiroaki Hata, Hironori Kawada, Shotaro Matsuda, Atsushi Itami, Kyoichi Hashimoto, Kenjiro Hirai, Sanae Nakajima, Hiroshi Okabe, Masazumi Sakaguchi, Yuichiro Kawamura, Takashi Sakamoto, Shintaro Okumura, Tatsuto Nishigori, Shigeru Tsunoda, Kazutaka Obama

  • July 20, 2026

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