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

Abstract

Of 550 patients with gastric cancer presenting in an 18-year period, 274 (49.8 %) underwent noncurative surgery. Surgery was noncurative due to invasion of adjacent organs (T4) in 19.7% of patients, extensive lymph node involvement (N₃) in 4%, unresectable distant metastases in 27.7% or a combination of all three conditions in 48.5% of cases. Resection was carried out in 41.4% of patients with primary situated in the antrum and in only 12.2.% with multicentric primary ( p < 0.001). Overall operative mortality was 29.9% in our series and did not differ significantly according to type of surgery. Mortality was 52% after total gastrectomy and 18% after subtotal gastric resection (p < 0.01). In patients undergoing resection, mortality increased significantly with age ( > 70 years old) and tumor stage. Six of the total 274 patients were alive 5 years from noncurative surgery. Subtotal gastric resection is the surgical procedure to be preferred. In the absence of distant metastases, resection should be considered in patients with primary situated in the body or antrum, with T₄N_0–2 or T₃N₃ lesions. Resection is also warranted when distant metastases can be excised.

Impact of lymph node metastasis on survival with early gastric cancer

“…A number of reports on the prognosis of patients with malignancies other than EGC have demonstrated that as the number of metastatic lymph nodes increases the posttreatment outcomes worsen [33][34][35][37][38][39][40][41][42]. In this study, however, the number of metastatic lymph nodes was not found to be of prognostic significance.…”

“…Lymph node metastasis has been regarded as a prognostic factor for esophageal [32][33][34][35] and colorectal [36,37] cancer. Many studies focused on gastric cancer have revealed that node involvement is associated with worse outcomes when the analyses include advanced tumors [38][39][40][41][42][43][44]. Even if the depth of tumor invasion is limited to the submucosa, the presence of metastatic lymph nodes is observed to decrease survival rates in esophageal [45,46] and colorectal [47] cancer.…”

Surgery for Stomach Cancer in a Defined Swedish Population: Current Practices and Operative Results

“…Opinions are divided as to whether total gastrectomy is a suitable procedure for palliation. Our data cannot be used to resolve this controversy, and the choice of operation must be made individually (5,35,37).…”