Is There a Role for Palliative Gastrectomy in Patients with Stage IV Gastric Cancer?

Abstract

Patients with metastatic gastric cancer are currently not considered operative candidates and are most often offered systemic therapy. Palliative resection of the primary tumor has been considered irrelevant to the outcome and has been recommended only for palliation of symptoms. We have examined the role of palliative gastrectomy and its impact on survival in patients with stage IV gastric cancer at initial diagnosis between 1990 and 2000. A total of 105 patients with stage IV disease were identified during this period; 81 of them (77.1%) had no resection, and 24 (22.9%) underwent palliative gastric resection. Mean survival in those without resection who received chemotherapy (with or without radiation) treatment was 5.9 months (95% confidence interval 4.2-7.6). For those with resection and adjuvant therapy, mean survival time was 16.3 months (95% confidence interval 4.3-28.8 months). Kaplan-Meier survival analysis showed significantly better survival in those with resection and adjuvant therapy (log-rank test, P = 0.01). Mortality and morbidity rates associated with palliative resection were 8.7% and 33.3%, respectively, which did not differ statistically from the 3.7% and 25.3% in patients who underwent curative gastrectomy during same period of time. However, the length of hospitalization (22 versus 16 days) was significantly higher compared with those without stage IV disease. These data suggest that palliative resection combined with adjuvant therapy may improve survival in a selected group of patients with stage IV gastric cancer. Palliative gastrectomy plus systemic therapy should be compared with systemic therapy alone in a randomized trial.

Survival benefit of gastrectomy ± metastasectomy in patients with metastatic gastric cancer receiving chemotherapy

“…A recent meta-analysis of randomized trials that compared chemotherapy and best supportive care in patients with MGC revealed that chemotherapy was more beneficial than best supportive care alone with respect to OS and quality of life [20]. However, the role of surgery (debulking gastrectomy or gastrectomy plus metastasectomy) in GC patients with distant metastasis is still controversial [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. The results of our study suggest that surgery may be beneficial in MGC patients when combined with chemotherapy.…”

“…Recently, some retrospective studies have shown significant survival benefits for palliative debulking gastrectomy in patients with MGC [11,[13][14][15][16][17][18]. Based on these results, some experts insist that debulking gastrectomy is the preferred choice for patients with MGC before the initiation of chemotherapy.…”

“…However, the role of metastasectomy is also controversial, as is that of debulking gastrectomy, because previous studies with small sample sizes have shown various outcomes, with a median OS of 11.2-31.0 months [4][5][6][7][8][9][10]. Moreover, most previous studies evaluating the benefit of gastrectomy ± metastasectomy in MGC were performed without considering the effect of systemic chemotherapy-the only proven standard treatment in MGC [19]-and thus both patients who had and had not received systemic chemotherapy were included [3][4][5][6][8][9][10][11][12][13][14][15][16][17][18]; this has made many clinicians confused about the real benefits of surgery in MGC.…”

“…GC mortality has remained high due to the frequent initial presentation with distant metastasis. Although surgery is mandatory for the cure of locoregional GC, the role of surgery for metastatic gastric cancer (MGC) is controversial [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. For patients with MGC, palliative chemotherapy and best supportive care are considered the only standard treatment to achieve extension of survival and palliation of symptoms [19].…”

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

“…Palliative resection relieves symptoms as well as maintains survival benefit in advanced gastric cancer. There are several studies that indicate the importance of palliative gastrectomy in Stage IV gastric cancer [1][2][3][4][5][6]. Stage IV gastric cancer is defined according to the American Joint Committeee on Cancer (AJCC, 6th edition), as M 1 , all N 3 , or T 4 N 1-3 M 0 (AJCC, 2003) [7].…”