Is palliative resection necessary for gastric carcinoma patients?

Kim, Dong Yi; Joo, Jae Kyoon; Ryu, Seong Yeob; Kim, Young Jin; Kim, Shin Kon; Lee, Jae Hyuk

doi:10.1007/s00423-007-0206-1

Cited by 18 publications

(18 citation statements)

References 15 publications

(21 reference statements)

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“…Based on the survival benefits, feasibility of non-curative gastrectomy for single organ metastasis, distant lymph node metastasis was generally accepted by many authors [10], [38]. Evidence existed of improved survival by non-curative gastrectomy in peritoneal metastatic disease, with the median OS ranging from 5 to 21.7 months [9], [38], [40]–[43]. However, the opposite evidence of gastrectomy or bypass in peritoneal metastasis also existed [10], [44] and authors failed to build consensus on the feasibility of surgery.…”

Section: Discussionmentioning

confidence: 99%

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

Zhang

Wang

et al. 2013

PLoS ONE

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BackgroundAlthough general agreement exists on palliative surgery with intent of symptom palliation in advanced gastric cancer (AGC), the role of non-curative surgery for incurable, asymptomatic AGC is hotly debated. We aim to clarify the role of non-curative surgery in patients with incurable, asymptomatic AGC under the first-line chemotherapy.MethodsA total of 737 patients with incurable, asymptomatic advanced gastric adenocarcinoma between January 2008 and May 2012 at the Sun Yat-sen University Cancer Center were retrospectively analyzed, comprising 414 patients with non-curative surgery plus first-line chemotherapy, and 323 patients with first-line chemotherapy only. The clinicopathologic data, survival, and prognosis were evaluated, with propensity score adjustment for selection bias.ResultsThe median overall survival (OS) outcomes significantly favored non-curative surgery group over first-line chemotherapy only group in entire population (28.00 versus 10.37 months, P = 0.000), stage 4 patients (23.87 versus 10.37 months, P = 0.000), young patients (28.70 versus 10.37 months, P = 0.000) and elderly patients (23.07 versus 10.27 months, P = 0.031). The median OS advantages of non-curative surgery over first-line chemotherapy only were also maintained when the analyses were restricted to single organ metastasis (P = 0.001), distant lymph node metastasis (P = 0.002), peritoneal metastasis (P = 0.000), and multi-organ metastasis (P = 0.010). Significant OS advantages of non-curative surgery over chemotherapy only were confirmed solid by multivariate analyses before and after adjustment on propensity score (P = 0.000). Small subsets of patients with surgery of single metastatic lesion after previous curative gastrectomy, and with surgery of both primary and single metastatic sites showed sound median OS.ConclusionsThere is a role for non-curative surgery plus first-line chemotherapy for incurable, asymptomatic AGC, in terms of survival. Randomized controlled trials are warranted to fill a gap in knowledge about the value of metastectomy and patient selection strategies.

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Section: Discussionmentioning

confidence: 99%

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

Zhang

Wang

et al. 2013

PLoS ONE

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“…Localization of the tumor in the stomach did not affect the survival [2,3]. Although the size of the tumor is considered as an important parameter in the study of Kunisaki et al [2], neither present study nor the study of Kim et al [11] supports this finding.…”

Section: Discussionmentioning

confidence: 51%

“…Neither in this study nor in the others, the age of the patient was determined as a factor that significantly affects survival [2,3,11]. On the other hand, Hartgrink et al [1] indicated that resection was not effective in patients who are older than 70 years of age with multiple metastases.…”

Section: Discussionmentioning

confidence: 54%

“…However, bilobar metastasis was determined as an important factor that affects survival in all patient groups and in RG by cox regression analysis. In literature there were studies supporting [4,10,13] and contradicting [2,11] these findings. The presence of ascites was a negative factor and resection was not applied to such patients.…”

Section: Discussionmentioning

confidence: 99%

“…In univariate analysis, metastatic progression-free survival seemed to be associated with localization of liver metastasis (p = 0.001), the number of liver metastasis (p = 0.004), existence of ascites (p = 0.02), peritoneal dissemination (p = 0.01), and primary tumor resection (p = 0.001). Kaplan-Meier curves are have stage IV metastasis were indicated in several studies [1][2][3][4][8][9][10][11][12][13]. The effect was not identified in only a few of these studies [14][15][16].…”

Section: Discussionmentioning

confidence: 99%

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The value of resection of primary tumor in gastric cancer patients with liver metastasis

Turanlı

2010

Indian J Surg

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Purpose Surgery for gastric cancer with synchronous liver metastasis is applied for palliation. The aim was to determine whether surgical removal of the primary tumor provides a better survival and disease progression Methods Sixty-two patients are classified according to the primary tumor were removed or not. Patients and tumor characteristics, removal of the primary tumor are examined as the factors that were affecting overall survival and metastatic progression-free survival. ResultsThe mean follow-up time was 243±23 days. The mean survival of the resection and nonresection groups were 422±50 and 170±16 days (p = 0.0001), respectively. After adjustment for other covariates, resection was associated with a trend toward improvement in overall survival (p = 0.003; relative risk RR: 0.34; 95% confidence interval (CI): 0.17-0.66) and improvement in metastatic progression-free survival (p = 0.07, RR = 0.51; 95% CI: 0.25-1.07).Conclusions Excision of the primary tumor has an effect on metastatic progression-free survival and overall survival.

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Stomach

Simpson,

Pointer,

Taghavi

2023

Hot Topics in Acute Care Surgery and Trauma

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Is palliative resection necessary for gastric carcinoma patients?

Abstract: The results highlight the improved survivorship of gastric carcinoma patients with palliative resection compared to those who did not undergo the procedure. Although curative resection is not possible in this group of patients, we recommend performing resection aimed at palliation.

Cited by 18 publications

References 15 publications

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

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

The value of resection of primary tumor in gastric cancer patients with liver metastasis

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