REGATTA trial: its achievement and the issues unsolved

In gastric cancer patients with distant metastases, the standard treatment is systematic chemotherapy that targets the circulating cancer cells throughout the body (1). As the life expectancy of such patients is very short, aggressive surgical treatments are considered unreasonable owing to the relatively high risk of postoperative morbidities that may delay chemotherapy. Several studies have shown that primary tumor excision improves the prognosis of these patients owing to favorable short-term outcomes after surgery as well as the reduction in tumor burden; hence, adjuvant chemotherapy becomes more amenable (2). However, whether removal of the primary cancer is beneficial for patients with distant metastases remains unclear.