Palliative resection in gastric cancer

Abstract

Fifty-one of 256 patients underwent a palliative procedure for advanced carcinoma of the stomach (TNM stage IV). The resection was classified as palliative if metastatic disease was left behind in the lymph nodes, if involvement of organs elsewhere in the abdominal cavity was present, or if microscopy revealed tumor tissue in the resection lines. Twenty-six patients underwent a resection for palliation. There were 14 total and 12 partial gastrectomies. There were 2 deaths after total gastrectomy because of anastomotic leakage. The mean survival time after operation was 9.5 months. In 13 patients (50%) palliation was good with preoperative symptomatic relief without initiating new symptoms, acceptable body weight, and solid food intake. In 7 patients (27%) palliation was moderate, and in 4 (15%) poor. The results after gastroenterostomy in 25 patients were poor. The study shows that palliative total and partial gastrectomy can produce palliation in advanced gastric cancer.

Variables Influencing the Choice and Outcome of Noncurative Surgery for Advanced Gastric Cancer

“…In fact, improved survival was observed in pa tients with resected métastasés [2,13]. It also appears that when gastric resection is the elected procedure, then subtotal gastric resection is to be preferred since it is associated with less operative mortality and better long term survival compared to total gastrectomy [3,6,8,14]. Both the modest improvement in median survival and the occasional long-term surviving patient observed af ter noncurative surgery justify its application in a wellselected patient population.…”

“…Noncurative surgical procedures for primary ad vanced gastric cancer are associated with a high inci dence of postoperative mortality [1,6,7,10]. Unfortu nately, the many variables that play an important role in the outcome of noncurative resection have not been well defined and there are no well-established guidelines for surgeons [3,8,11,12], Of 550 patients with primary gastric cancer present ing in an 18-year period, 274 (49.8%) underwent noncu rative surgery.…”

“…In these cases, an attempt to prolong survival and alleviate symptoms can be made by adopting noncura tive procedures such as gastroenterostomy, gastrostomy, jejunostomy or resection [1][2][3]. Of these procedures, gas tric resection appears to have the greater therapeutic sig nificance [4][5][6][7], The surgeon does not, however, have dependable parameters on which to base his choice of the surgical procedure [3,8]. We reviewed the histories of 274 patients with gastric cancer who underwent non curative treatment to identify intraoperative parameters that influence the surgical choice and prognosis.…”

Clinical Pathway for the Management of Resectable Gastric Cancer with Peritoneal Seeding: Best Palliation with a Ray of Hope for Cure

“…In 1983, Meijer et al [13]from the Free University Hospital, Amsterdam reported on 51 patients who underwent a palliative procedure for advanced carcinoma of the stomach. Twenty-six of these patients underwent a palliative resection.…”

Benefit of Resection in Palliative Surgery

“…Most of our patients with advanced disease are traditionally candidates for 'pallia tion' comprising either resection or a bypass procedure. The aim of palliative surgery is to improve the quality of life without producing new symptoms or incurring excess mortality or morbidity, and for some patients even to pro long comfortable survival [12], Several studies show that only tumor resection offers such potentials in patients with symptomatic disease [2,8,[13][14][15][16]. However, in many patients resection is technically impossible to per form, and the only treatment option for a tumor causing stenosis might be a gastroenterostomy or some endoscop ic procedure.…”