Does non‐curative gastrectomy improve survival in patients with metastatic gastric cancer?

Kokkola, Arto; Louhimo, Johanna; Puolakkainen, Pauli

doi:10.1002/jso.23066

Cited by 41 publications

(31 citation statements)

References 23 publications

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“…Both positive and negative findings have been noted in retrospective studies [5–13]. However, none of the studies analyzed the survival benefit of palliative gastrectomy in subgroups of patients.…”

Section: Discussionmentioning

confidence: 99%

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Palliative Gastrectomy Prolongs Survival of Metastatic Gastric Cancer Patients with Normal Preoperative CEA or CA19-9 Values: A Retrospective Cohort Study

Chiu

Yang

et al. 2016

Gastroenterology Research and Practice

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Background. Palliative gastrectomy has been suggested to improve survival of patients with metastatic gastric cancer, but limitations in study design and availability of robust prognostic factors have cast doubt on the overall merit of this procedure. Methods. The characteristics and clinical outcomes of 173 patients diagnosed between 2008 and 2012 were analyzed to determine the value of palliative gastrectomy and to identify potential prognostic factors. Results. Median overall patient survival was 6.5 months. To attenuate potential selection bias, patients with adequate performance and survival time of ≥ 2 months since diagnosis were included for risk factor analysis (n = 137). The median overall survival was longer for patients who were younger than 60 years, had better performance status (8.7 versus 6.4 months, P = 0.015), received systemic chemotherapy, or had palliative gastrectomy in univariate analyses. Gastrectomy (P = 0.002) remained statistically significant in multivariate analyses. Subgroup analysis showed that patients aged < 60 years, CEA < 5 ng/mL or CA19-9 < 35 U/mL, obtained a survival advantage from palliative gastrectomy. In fact, palliative gastrectomy doubled overall survival for patients who had normal CEA and/or normal CA19-9. Conclusions. Palliative gastrectomy prolongs the survival of metastatic gastric cancer patients with normal CEA and/or CA19-9 level at the time of diagnosis.

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Section: Discussionmentioning

confidence: 99%

“…While some studies found a protective role for palliative gastrectomy in overall survival of patients with metastatic gastric cancer [5–10], others did not [11–13]. The major issue underlying the controversy is that none of the studies was prospectively and randomly designed.…”

Section: Introductionmentioning

confidence: 99%

Palliative Gastrectomy Prolongs Survival of Metastatic Gastric Cancer Patients with Normal Preoperative CEA or CA19-9 Values: A Retrospective Cohort Study

Chiu

Yang

et al. 2016

Gastroenterology Research and Practice

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“…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.…”

Section: Discussionmentioning

confidence: 99%

Does surgery have a role in managing incurable gastric cancer?

et al. 2015

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Although the incidence of gastric cancer is decreasing, the outcomes of this disease are among the poorest of all solid-organ tumours, predominantly due to the frequent presence of stage IV metastatic disease at primary presentation. Stage IV gastric cancer is incurable and carries a very poor prognosis (5-year survival rate of ∼4%); palliative chemotherapy remains the standard of care, but increasing evidence indicates that palliative surgery can provide a prognostic and symptomatic benefit, particularly in combination with chemotherapy and/or radiotherapy. Ongoing prospective trials should further clarify the efficacy of palliative surgery in comparison with other treatment modalities. Until such data are available, surgery should not be offered as a standard first-line treatment, but can be considered in selected cases after thorough multidisciplinary discussions involving the patient. Patient selection for both gastrectomy and nonresectional surgery must include consideration of various factors that predict quality of life after surgery. This Perspectives summarizes the available evidence and discusses the utility of palliative surgery in relation to other therapeutic modalities in the management of incurable gastric cancer.

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“…Data regarding the value of palliative gastric resection come largely from retrospective series without real consensus regarding survival advantage. 20,21 However, a generalized consensus exists that a palliative resection can be recommended only for patients of reasonable physical condition, where metastatic disease is limited in extent, or where warranted by symptoms. Patients with advanced disease are often malnourished and have less physiological reserve, and the potential benefit of palliative resection needs to be balanced against the heightened surgical risks and the effect on quality of life.…”

Section: Commentmentioning

confidence: 99%

Predictive Factors of Postoperative Mortality After Junctional and Gastric Adenocarcinoma Resection

et al. 2013

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for the FREGAT Working Group-FRENCH IMPORTANCE Postoperative mortality after junctional and gastric adenocarcinoma resection remains a significant issue.OBJECTIVE To identify factors predictive of mortality within 30 days of junctional and gastric adenocarcinoma resection in a large national multicenter cohort.DESIGN A retrospective study collecting data from a multicenter database of patients who underwent resection for junctional and gastric adenocarcinoma from January 1, 1997, through January 31, 2010. A stepwise logistic regression model was built to identify, by multivariate analysis, variables independently predictive of 30-day postoperative mortality (POM). SETTING Nineteen university teaching hospitals in France.PARTICIPANTS Two thousand six hundred seventy patients with available data.MAIN OUTCOME MEASURES The primary end point was POM. Secondary end points included (1) late mortality (30-90 days after resection) and (2) postoperative morbidity. RESULTSOne thousand eight hundred ninety-six patients (71.01%) had gastric adenocarcinoma and 774 (28.99%) had junctional tumors. Neoadjuvant treatment was given to 655 patients (24.53%), and 114 patients (4.27%) died within 30 days of surgery. Postoperative mortality was higher in patients who experienced grades III and IV toxic effects during neoadjuvant treatment compared with those who did not (8.7% vs 2.9%, respectively; P = .007). Multivariate analysis revealed metastatic disease at diagnosis (odds ratio, 9.13 [95% CI, 3.29-25.35]; P < .001) and poor tolerance of neoadjuvant treatment (3.33 [1.25-8.85]; P = .02) as being independently predictive of POM. Centers performing at least 10 resections per year were found to be protective against POM (odds ratio, 0.29 [95% CI,; P = .008).CONCLUSIONS AND RELEVANCE This large national cohort study confirms that advanced disease heightens the risk of POM; centralization of junctional and gastric adenocarcinoma resection is warranted. The novel finding that grades III to IV toxic effects during neoadjuvant therapy increase POM has significant implications for decision making in this subgroup of patients.

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Does non‐curative gastrectomy improve survival in patients with metastatic gastric cancer?

Cited by 41 publications

References 23 publications

Palliative Gastrectomy Prolongs Survival of Metastatic Gastric Cancer Patients with Normal Preoperative CEA or CA19-9 Values: A Retrospective Cohort Study

Palliative Gastrectomy Prolongs Survival of Metastatic Gastric Cancer Patients with Normal Preoperative CEA or CA19-9 Values: A Retrospective Cohort Study

Does surgery have a role in managing incurable gastric cancer?

Predictive Factors of Postoperative Mortality After Junctional and Gastric Adenocarcinoma Resection

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