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Review
. 2025 Nov 18.
doi: 10.1007/s12094-025-04123-5. Online ahead of print.

Role of surgery in metastatic gastric cancer

Israel Manzanedo  1   2 , Ángel Serrano  3   4 , Estíbalitz Pérez-Viejo  3 , Fernando Pereira Pérez  3   4
Affiliations
Review

Role of surgery in metastatic gastric cancer

Israel Manzanedo et al. Clin Transl Oncol. .

Abstract

Gastric cancer is frequently diagnosed at an advanced stage, leading to a poor overall prognosis, particularly in regions without population-based screening. Stage IV disease, defined by distant metastases, is associated with dismal survival outcomes. Current management is primarily palliative, consisting of systemic therapy-chemotherapy, immunotherapy, or targeted agents tailored to molecular biomarkers. Despite the recent therapeutic advances, durable survival remains rare. In selected patients with limited metastatic disease, surgical resection has emerged as a potential therapeutic strategy, with reports of favorable oncological outcomes. Several international guidelines and consensus statements now acknowledge surgery as an option in patients who demonstrate stable disease after a period of systemic therapy. The central challenge is the accurate identification of patients most likely to benefit from surgical intervention and the precise delineation of low-volume metastatic disease. This review synthesizes the available evidence on the role of surgery in the management of metastatic gastric cancer.

Keywords: Gastric cancer; HIPEC; Liver metastases; Lymph node metastases; Peritoneal metastases; Surgery.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no conflict of interest or funding. Ethical approval: The current study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent: Since this article is a literature review, no patient data has been collected, so informed consent is not required in this case. Data availability: As the article is a literature review, no new patient data have been added.

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