Advisability of Palliative Resections in Incurable Advanced Gastric Cancer

Abstract

Effective treatment is the primary objective of surgeon in the treatment of advanced gastric cancer. Poor prognosis and significant advancement of gastric cancer at the time of diagnosis are decisive factors for the only possible surgical management method being palliative procedures. the aim of the study was the evaluation of the value of palliative resection procedures in patients with advanced gastric cancer. Material and methods. The subject in the study was a group of 105 patients with gastric adenocarcinoma at stage 4 of advancement, in whom curative treatment was not possible. The group constituted 44.5% of patients operated on due to gastric cancer at the Department of General and Oncological Surgery, PUM, in the years 1998-2009. The patients were divided into two groups: the first one comprised 44 patients post palliative resections, the second -61 patients post non-resection procedures. The subject of analysis were early and late treatment results post palliative resections, and they were compared with the treatment results post non-resection procedures. Results. Palliative resections were performed in 44 patients (19 females and 25 males), while in 61 patients (38 males and 23 females) non-resection procedures were performed. Postoperative complications were observed in 25% of patients in the group post palliative resections and in 11.5% in the group of patients without the resection of primary focus. In-hospital mortality stood at 4.5% in the group post palliative resections and 4.8% in the group post non-resection procedures. The percentage of 1-year and 4-year survival post palliative resections stood at 43% and 8.8%, respectively. In the group without the resection of primary focus, 16% survived 1 year and nobody survived 2 years. conclusions. Palliative resections improve the survival of patients with incurable gastric cancer and should be considered if only the loco-regional conditions are favourable.

A Distinct Clinicopathological Feature and Prognosis of Young Gastric Cancer Patients Aged ≤ 45 Years Old

“…Our findings suggest that the prognosis of young individuals with advanced or unresectable gastric cancer is worse than that of elderly patients and age is a significant independent factor associated with worse prognosis in patients with unresectable gastric cancer. Our study also found that palliative resection can improve the survival of young patients with incurable gastric cancer ( P = 0.0003) ( 22 , 23 ). Therefore, palliative resection may be considered for advanced and incurable young patients with good basic physical condition.…”

The Role of Non-Curative Surgery in Incurable, Asymptomatic Advanced Gastric Cancer

“…The non-curative surgery with the intent of symptom palliation, which usually included resectional surgery and non-resectional surgery such as surgical bypass, achieved a narrow range of median OS from 3 to 13 months [18], [29]–[32]. Evidence showed the significantly superior survival prognosis of the non-palliative, non-curative resection than palliative, non-curative resection [12] and palliative bypass [33], [34]. In comparison to many studies with mixed intents, one important reason for this long median OS (28 months) of non-curative surgery group is that we centered on non-palliative, non-curative resections for asymptomatic patients in most recent years.…”

Does surgery have a role in managing incurable gastric cancer?

“…Median overall survival durations of 8.5-13.8 months have been reported following resectional surgery alone as the principal treatment modality for patients with incurable gastric cancer, 18,25,[53][54][55][56][57] compared with a median overall survival of 13.8 months for patients HER2-positive tumours who received trastuzumab in the TOGA trial. 49 The comparable survival demonstrated for these treatment modalities suggests that an individualized, patient-centred multidisciplinary approach should be advocated, offering either operative or nonoperative treatment after careful risk stratification.…”