Role of Surgery in the Management for Gastric Cancer with Synchronous Distant Metastases

Abstract

Optimal treatment of patients with gastric cancer with synchronous distant metastases is palliative chemotherapy. However, occasionally gastrectomy should be selected due to control bleeding from tumors, perforation, or obstruction. The aim of this study is to evaluate the survival benefits of non-curative gastrectomy for patients with synchronous distant metastasis. Total 78 gastric cancer patients with synchronous distant metastasis treated in our hospital between 2003 and 2012 were enrolled in this study. Of these, 74 patients (95 %) received S1 based chemotherapy. During the treatment, 37 patients (47.4 %) underwent palliative gastrectomy because of bleeding from tumors (n=15), tumor perforation (n=6), and obstruction (n=16). Survival benefits were compared in resected and non-resected patients, retrospectively. The two groups were clinicopathologically similar. Palliative gastrectomy was performed safely (morbidity: 10.8 % and mortality: 0) in resection group. However, resection showed survival benefits only in 13 patients (16.7 %) with single metastasis and without peritoneal metastasis. Their 2-year survival rate was 40 % and their median survival was 19 months. Non-curative gastrectomy with precise surgical techniques followed careful postoperative nutrition management may improve survival only for patients with a single metastatic site, except for peritoneal dissemination.

Palliative gastrectomy plus chemotherapy versus chemotherapy alone for incurable advanced gastric cancer: a meta-analysis

“…Some studies have shown that palliative gastrectomy obtained no survival benefit in patients with peritoneal metastases. 32 , 40 – 42 However, our analysis demonstrated that both peritoneal metastasis (HR=0.46, 95% CI=0.28–0.73, I 2 =61%) and hepatic metastasis (HR=0.46, 95% CI=0.33–0.65, I 2 =0%) benefited from palliative gastrectomy combined with chemotherapy.…”

“… 31 According to the 2009 annual conference of the JGCA, the 5-year OS was 88% in resected patients without residual tumors, 1.5% in unresected patients, and 9.9% in resected patients with residual tumors, which indicates that palliative gastrectomy could improve the survival of advanced gastric cancer patients and give them a good prognosis. 32 , 33 From another perspective, palliative gastrectomy may be beneficial for incurable advanced gastric cancer because it relieves the symptoms of advanced gastric cancer, including obstruction and bleeding, but it also prevents perforation or debilitating ascites to improve the quality of life. In addition, palliative gastrectomy can reduce the tumor burden to improve the response to adjuvant modalities and enhance the immunologic benefit due to the immunosuppressive cytokines produced by the tumor itself.…”

Gastrectomy for Metastatic Gastric Cancer: a 15-year Experience from a Developing Country

“…Several studies underscore the importance of patient selection for gastrectomy considering the risk factors such as patient age and performance status [6,[12][13][14][21][22][23][24]. Based on our experience, we believe that patient age itself is not a contraindication for gastrectomy, if the performance status is satisfactory.…”

LINC00562 drives gastric cancer development by regulating miR-4636–AP1S3 axis

“…GC is associated with complex genetic and environmental interactions and is therefore considered to be a heterogeneous disease [ 2 ]. Despite the development of interventions such as gastrectomy and adjuvant chemotherapy, patients with GC have a poor prognosis because of the frequency of lymphatic or distant metastases [ 3 ]. Epigenetic changes are closely associated with GC invasion, metastasis, and chemoresistance [ 4 , 5 ].…”