Surgical Management of Oligometastatic Gastric Cancer: a Systematic Review

Abstract

Gastric cancer remains a leading cause of cancer-related mortality, with many patients presenting with metastatic disease at diagnosis. Oligometastatic gastric cancer (OMGC) is increasingly recognized as a distinct entity, potentially amenable to multimodal treatment, including surgical resection. This systematic review evaluated the impact of surgery on survival and postoperative outcomes in OMGC patients. Conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature research was performed using PubMed, Web of Science, and Cochrane Library. Studies assessing surgical treatment in OMGC were included. Data on overall survival (OS), progression-free survival (PFS), R0 resection rates, postoperative complications, and chemotherapy tolerance were extracted. Study quality was assessed using the MINORS scale. An extensive assessment of treatment strategies, including surgical and systemic therapies, as well as baseline patient characteristics, was performed. Eleven studies on surgical treatment in OMGC were identified. The studies demonstrated heterogeneity in patient selection, metastatic site definitions, and treatment approaches. Despite this, multiple studies reported favorable OS and PFS following surgery, particularly in well-selected patients with limited metastases and a good response to chemotherapy. High R0 resection rates supported the feasibility of complete tumor removal, though surgical morbidity varied. Findings suggest surgery may improve outcomes in OMGC, offering a survival benefit for selected patients. However, these results remain insufficient to change clinical guidelines. Clarification of OMGC's definition and further high-quality RCTs are needed to validate these findings and refine optimal patient selection.