title: Palliation of metastatic gastric cancer: impact of preoperative symptoms and the type of operation on survival and quality of life.
abstract: Patients with advanced, incurable gastric cancer may present with mild symptoms or require immediate therapeutic intervention. The influence of the intensity of preoperative symptoms on postoperative survival and quality of life (QoL) was evaluated in a palliative setting. In a historical cohort analysis of 492 patients with gastric cancer treated between 1992 and 2001, a total of 169 (34.4%) patients had incurable disease (i.e., pTxNxM1). Patients were classified as having major symptoms if they presented with upper gastrointestinal bleeding (i.e., hematemesis or bloody stools), gastric inlet or outlet obstruction (i.e., symptomatic and endoscopically proven stenosis), or perforation caused by the tumor. All other patients were defined as having minor symptoms. QoL was assessed prospectively using the EORTC questionnaire. The questionnaire was given to the patients before operation, before discharge, and 3 months after operation; and it was analyzed by the Mann-Whitney U-test. Survival, demographic data, and histopathologic characteristics were assessed and analyzed by the log-rank test and the chi(2) test, respectively. Of the 169 patients, 75 (44.3%) presented with major symptoms and 94 (55.7%) with minor symptoms. The distribution of patients undergoing resection or exploration was comparable for the two groups [major: 61 (81.5%)/14 (18.5%); minor: 77 (81.9%)/17 (18.1%)]. Despite comparable demographic and histopathologic characteristics with equal hospital mortality and morbidity (14.6% vs. 8.5%/49.3% vs. 40.4%), the median survival rates in two groups were 4 and 6 months, respectively ( p < 0.05). This was not influenced by the type of operation. QoL was not different in patients with major or minor symptoms before operation or 3 months thereafter. However, preoperative symptoms such as nausea/vomiting and melena were rated significantly higher in patients with major symptoms. In patients with incurable gastric cancer the preoperative intensity of symptoms has a significant impact on survival and QoL, which is not influenced by the operation. The necessity of surgery in patients with minor symptoms requires careful consideration.
authors.affiliation: Department of General and Thoracic Surgery, University of Kiel, Arnold-Heller-Strasse 7, 24105 Kiel, Germany. vkahlke@surgery.uni-kiel.de
authors.forename: Volker
authors.initials: V
authors.lastname: Kahlke
authors.forename: Beate
authors.initials: B
authors.lastname: Bestmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Schmid
authors.forename: Julius Marek
authors.initials: JM
authors.lastname: Doniec
authors.forename: Thomas
authors.initials: T
authors.lastname: Küchler
authors.forename: Bernd
authors.initials: B
authors.lastname: Kremer
mesh_terms: D000368:Aged; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010534:Peritoneal Neoplasms / Q000556:secondary; D011788:Quality of Life; D012422:Rupture, Spontaneous / Q000209:etiology / Q000401:mortality / Q000601:surgery; D013156:Splenectomy; D013274:Stomach Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate