Palliative gastrectomy and chemotherapy for stage IV gastric cancer

Abstract

The survival time and palliative duration were significantly longer in patients after PG than after non-resection operations. Postoperative chemotherapy prolonged the survival time of patients after palliative surgery. PG combined with adjuvant chemotherapy may improve survival in patients with stage IV gastric cancer, even with liver metastasis, peritoneal dissemination, and lymph node metastasis.

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.…”

“…Although systemic chemotherapy is the only proven standard treatment of MGC [19], most previous studies evaluating the benefit of gastrectomy ± metastasectomy in MGC were performed without considering the influence of chemotherapy. In most previous studies [3][4][5][6][8][9][10][11][12][13][14][15][16][17][18], both patients who had and had not received systemic chemotherapy were included. Therefore, many clinicians have been confused about the results, insisting on the benefits of surgery in stage IV (M 1 ) GC, based on results derived from heterogeneous patient populations.…”

“…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].…”

“…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.…”