Assessing the Role of Surgery in Clinical Complete Response of Advanced Gastric Cancer

Retrospective single‑center data published in Annals of Surgical Oncology suggest that select patients with advanced gastric cancer who achieve a radiologic and clinical disappearance of measurable disease after systemic therapy—clinical complete response (cCR)—may have similar long‑term survival whether observed or taken to conversion surgery, challenging routine resection for durable responders.

The study screened patients treated from 2013–2023. Of 1,591 patients who received systemic therapy, 51 (3.2%) met the protocol definition of cCR. Within that cCR cohort, 33 were managed non‑operatively and 18 underwent conversion surgery. Median follow‑up for the cCR group was 57 months, and the prespecified primary endpoint was 3‑year overall survival.

At 3 years, overall survival was 97% in the non‑operative group versus 86% in the surgical group among patients with Stage IVB gastric cancer who achieved cCR. This difference was not statistically significant (P = 0.44). In this selected sample, observation and conversion resection yielded comparable long‑term survival.

Surgical eligibility required a clinical complete response with no radiologic evidence of disease, and decisions for conversion resection were made after multidisciplinary review. That protocol‑driven approach was nonetheless constrained by imaging sensitivity, which limits certainty about true tumor eradication.

Pathologic complete response (pCR) was observed in 17 of 121 (14%) patients who underwent conversion surgery overall; 10 of those 17 had previously met cCR. Separately, 18 patients from the 51‑patient cCR cohort underwent conversion surgery. Patients with pCR had a 3‑year overall survival of 93%. The retrospective design, selection bias and small subgroup counts preclude causal inference about whether surgery changed outcomes.