---
title: "Conversion Surgery After Immunochemotherapy for Gastric Cancer With Peritoneal Metastasis or Posit"
id: "pubmed-42236320"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42236320"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42236320/"
doi: "10.1097/CM9.0000000000004095"
published_at: "2026-08-05T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Conversion Surgery After Immunochemotherapy for Gastric Cancer With Peritoneal Metastasis or Posit
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42236320
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42236320/)
- **DOI:** [10.1097/CM9.0000000000004095](https://doi.org/10.1097%2FCM9.0000000000004095)
- **Published At:** 2026-08-05T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This retrospective single-institution cohort evaluated 144 gastric cancer patients with **peritoneal metastasis (P1)** and/or **positive peritoneal cytology (CY1)** confirmed by staging laparoscopy who received first-line immunotherapy plus chemotherapy and/or trastuzumab between November 2019 and March 2024. - Seventy-five patients demonstrated a clinical response and underwent second-look laparoscopy; 36 of those had negative peritoneal metastasis and cytology and proceeded to **conversion surgery**. - The conversion surgery group had significantly longer median progression-free survival (22.9 vs. 5.8 months) and overall survival (33.4 vs. 12.3 months) compared with the palliative group (P 2 (median not reached vs. 28.5 months; P < 0.006). - No serious treatment-related adverse events were reported that led to treatment discontinuation or death in the study cohort. - The authors conclude that when immunochemotherapy is effective, active staging laparoscopy should be used to reassess feasibility and consider conversion surgery, which provided a substantial survival benefit in this population.
## Clinical Analysis & Structured Key Points
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Epub 2026 Jun 3. # Conversion surgery after immunotherapy and chemotherapy for gastric cancer with peritoneal metastasis or positive peritoneal cytology: A retrospective cohort study [Huayuan Liang](https://pubmed.ncbi.nlm.nih.gov/?term=Liang+H&cauthor_id=42236320)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#full-view-affiliation-1 "Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#full-view-affiliation-2 "Department of Gastrointestinal Surgery, Cancer Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing 102218, China."), [Hailun Huang](https://pubmed.ncbi.nlm.nih.gov/?term=Huang+H&cauthor_id=42236320)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#full-view-affiliation-3 "Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China."), [Qing Xie](https://pubmed.ncbi.nlm.nih.gov/?term=Xie+Q&cauthor_id=42236320)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#full-view-affiliation-1 "Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China."), [Kaihua Huang](https://pubmed.ncbi.nlm.nih.gov/?term=Huang+K&cauthor_id=42236320)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#full-view-affiliation-1 "Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China."), [Zhiwei Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+Z&cauthor_id=42236320)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#full-view-affiliation-1 "Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China."), [Huimin Zhang](https://pubmed.ncbi.nlm.nih.gov/?term=Zhang+H&cauthor_id=42236320)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#full-view-affiliation-1 "Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China."), [Rou Zhong](https://pubmed.ncbi.nlm.nih.gov/?term=Zhong+R&cauthor_id=42236320)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#full-view-affiliation-1 "Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China."), [Xiao Yan](https://pubmed.ncbi.nlm.nih.gov/?term=Yan+X&cauthor_id=42236320)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#full-view-affiliation-1 "Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China."), [Min Lai](https://pubmed.ncbi.nlm.nih.gov/?term=Lai+M&cauthor_id=42236320)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#full-view-affiliation-1 "Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China."), [Liying Zhao](https://pubmed.ncbi.nlm.nih.gov/?term=Zhao+L&cauthor_id=42236320)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#full-view-affiliation-1 "Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China."), [Guoxin Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+G&cauthor_id=42236320)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#full-view-affiliation-2 "Department of Gastrointestinal Surgery, Cancer Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing 102218, China.") Affiliations Expand ### Affiliations * 1 Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China. * 2 Department of Gastrointestinal Surgery, Cancer Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing 102218, China. * 3 Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China. * PMID: **42236320** * DOI: [ 10.1097/CM9.0000000000004095 ](https://doi.org/10.1097/cm9.0000000000004095) Item in Clipboard # Conversion surgery after immunotherapy and chemotherapy for gastric cancer with peritoneal metastasis or positive peritoneal cytology: A retrospective cohort study Huayuan Liang et al. Chin Med J (Engl). 2026. Show details Display options Display options Format Abstract PubMed PMID Chin Med J (Engl) Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Chin+Med+J+%28Engl%29%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Chin+Med+J+%28Engl%29%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42236320/) . 2026 Aug 5;139(15):2346-2355. doi: 10.1097/CM9.0000000000004095. Epub 2026 Jun 3. ### Authors [Huayuan Liang](https://pubmed.ncbi.nlm.nih.gov/?term=Liang+H&cauthor_id=42236320)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#short-view-affiliation-1 "Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#short-view-affiliation-2 "Department of Gastrointestinal Surgery, Cancer Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing 102218, China."), [Hailun Huang](https://pubmed.ncbi.nlm.nih.gov/?term=Huang+H&cauthor_id=42236320)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#short-view-affiliation-3 "Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China."), [Qing Xie](https://pubmed.ncbi.nlm.nih.gov/?term=Xie+Q&cauthor_id=42236320)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#short-view-affiliation-1 "Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China."), [Kaihua Huang](https://pubmed.ncbi.nlm.nih.gov/?term=Huang+K&cauthor_id=42236320)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#short-view-affiliation-1 "Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China."), [Zhiwei Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+Z&cauthor_id=42236320)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#short-view-affiliation-1 "Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China."), [Huimin Zhang](https://pubmed.ncbi.nlm.nih.gov/?term=Zhang+H&cauthor_id=42236320)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#short-view-affiliation-1 "Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China."), [Rou Zhong](https://pubmed.ncbi.nlm.nih.gov/?term=Zhong+R&cauthor_id=42236320)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#short-view-affiliation-1 "Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China."), [Xiao Yan](https://pubmed.ncbi.nlm.nih.gov/?term=Yan+X&cauthor_id=42236320)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#short-view-affiliation-1 "Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China."), [Min Lai](https://pubmed.ncbi.nlm.nih.gov/?term=Lai+M&cauthor_id=42236320)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#short-view-affiliation-1 "Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China."), [Liying Zhao](https://pubmed.ncbi.nlm.nih.gov/?term=Zhao+L&cauthor_id=42236320)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#short-view-affiliation-1 "Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China."), [Guoxin Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+G&cauthor_id=42236320)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42236320/#short-view-affiliation-2 "Department of Gastrointestinal Surgery, Cancer Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing 102218, China.") ### Affiliations * 1 Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China. * 2 Department of Gastrointestinal Surgery, Cancer Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing 102218, China. * 3 Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China. * PMID: **42236320** * DOI: [ 10.1097/CM9.0000000000004095 ](https://doi.org/10.1097/cm9.0000000000004095) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** The efficacy of conversion therapy for gastric cancer with peritoneal metastasis (P1) and/or positive peritoneal lavage cytology (CY1) treated with immunotherapy remains unclear. This study aimed to clarify clinical outcomes in this setting. **Methods:** In this retrospective, single-institution cohort study, 144 patients with P1 and/or CY1 confirmed by staging laparoscopy at initial diagnosis received first-line immunotherapy with chemotherapy and/or trastuzumab between November 2019 and March 2024. Patients were divided into a conversion therapy group and a palliative therapy group. **Results:** Of 144 patients, 75 showed a clinical response and underwent second-look laparoscopy. Negative peritoneal metastasis and cytology were confirmed in 36 patients, all of whom underwent conversion surgery. Compared with the palliative group, the conversion group had significantly longer median progression-free survival (22.9 vs . 5.8 months; P 2 (not reached vs . 28.5 months; P <0.006). No serious treatment-related adverse events led to treatment discontinuation or death. **Conclusions:** Conversion surgery following immunochemotherapy provided a significant survival benefit for gastric cancer patients with P1 and/or CY1. When immunochemotherapy is effective, active staging laparoscopy should be performed to assess surgical feasibility. **Keywords:** Chemotherapy; Conversion surgery; Gastric cancer; Immunotherapy; Peritoneal cytology; Peritoneal metastasis. Copyright © 2026 The Chinese Medical Association, produced by Wolters Kluwer Health, LLC. under the CC-BY-NC-ND license. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Surgery after intraperitoneal and systemic chemotherapy for gastric cancer with peritoneal metastasis or positive peritoneal cytology findings. ](https://pubmed.ncbi.nlm.nih.gov/28028665/) Ishigami H, Yamaguchi H, Yamashita H, Asakage M, Kitayama J.Ishigami H, et al.Gastric Cancer. 2017 Mar;20(Suppl 1):128-134. doi: 10.1007/s10120-016-0684-3. Epub 2016 Dec 27.Gastric Cancer. 2017.PMID: 28028665 * [ [Application of laparoscopic exploration combined with abdominal exfoliative cytology in the diagnosis and treatment of locally advanced gastric cancer]. ](https://pubmed.ncbi.nlm.nih.gov/32074798/) Ding PA, Liu Y, Guo HH, Yang PG, Tian Y, Fan LQ, Tan BB, Li Y, Zhao Q.Ding PA, et al.Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Feb 25;23(2):170-176. doi: 10.3760/cma.j.issn.1671-0274.2020.02.013.Zhonghua Wei Chang Wai Ke Za Zhi. 2020.PMID: 32074798Clinical Trial.Chinese. * [ Clinical significance of initial treatment for peritoneal lavage cytology-positive gastric cancer: outcomes according to treatment strategy. ](https://pubmed.ncbi.nlm.nih.gov/35168610/) Yago A, Haruta S, Ueno
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