Benefits of palliative surgery for far-advanced gastric cancer.
BACKGROUND
The optimum strategy for palliative surgery in gastric cancer patients remains undetermined.


METHODS
In total, 525 patients who had undergone palliative surgery between 1994 and 2000 were evaluated in terms of operative mortality, survival, and palliative effect. Patients were grouped according to the UICC's classification of residual tumors (R) after the operation: microscopic residual tumor (R1) (N = 104) and macroscopic residual tumor (R2) (N = 421). Gastric resection was performed in all R1 patients and in 257 of the R2 patients. Non-resection procedures were performed in 164 of the R2 patients, including gastrojejunostomies in 64, gastrostomies in 17, jejunostomies in 60, and laparotomies only in 23.


RESULTS
The operative mortality did not significantly differ among R1 distal gastrectomies (4.5%), R2 distal gastrectomies (3.3%), and R1 total gastrectomies (2.9%) (p = 0.919). R2 total gastrectomies showed a particularly higher operative mortality (10.9%) than did the other resection procedures. The survival time and palliative duration were significantly longer in patients after palliative resection than after non-resection operations. Postoperative chemotherapy prolonged the survival time of patients after palliative surgery.


CONCLUSIONS
R1 or R2 distal gastrectomies and R1 total gastrectomies have benefits of survival prolongation and symptomatic palliation. However, the use of a total gastrectomy in R2 patients must be selectively reserved for far-advanced cases, otherwise it should be replaced with less-invasive procedures to avoid a high operative mortality rate. Postoperative chemotherapy is useful for prolonging survival time.
Wang
Chia-Siu
CS
Department of General Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC. wangcs@cgmh.org.tw
Chao
Tzu-Chieh
TC
Jan
Yi-Yin
YY
Jeng
Long-Bin
LB
Hwang
Tsann-Long
TL
Chen
Miin-Fu
MF
D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011183:Postoperative Complications; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate