title: Does the surgical stress associated with palliative resection for patients with incurable gastric cancer with distant metastasis shorten their survival?
abstract: OBJECTIVE
  In cases of incurable stage IV gastric cancer with distant metastases, surgical treatment has usually consisted merely of palliation. The effect of palliative resection in these highly advanced cases remains controversial. Palliative resection may be prohibited by the potential disadvantages of surgical stress.
  
  
  METHODS
  Over the past 23 years, 382 stage IV incurable gastric cancer patients with distant metastases were classified into a resection group (group R) whose subjects underwent a palliative resection of the primary tumor and the non-resection group (group N) who were treated without resection of primary tumor. In order to exclude patients with very poor prognosis due to irresectability even if trying to resect, we restricted the subjects to patients who survived more than 30 and 60 days and some months and estimated the mean survival. Cumulative survival rates were calculated by using the Kaplan-Meier method, and the mean survivals of groups R and N were compared.
  
  
  RESULTS
  A significantly longer mean survival was observed in group R than in group N (381 vs. 181 days, P<0.0001). Restricting the subjects to patients who survived more than 30 and 60 days, there is also a significant difference between the mean survival of group R and that of group N. However, restricting the subjects to patients who survived more than 300 days, no significant difference was seen between the two groups. The rate of hospital death was higher in group N than in group R (15.9% vs. 3.4%)
  
  
  CONCLUSIONS
  Palliative resection of the primary tumor in stage IV gastric cancer is meaningful in view of hospital stay, long-term survival, and satisfaction with the treatment. We should resect the primary tumor in cases in which it is resectable.
authors.affiliation: Department of Surgery, Fujisawa Municipal Hospital, Kanagawa, Japan. qqc3@urahp.yokohama-cu.ac.jp
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Moriwaki
authors.forename: Chikara
authors.initials: C
authors.lastname: Kunisaki
authors.forename: Syunsuke
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Harada
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Imai
authors.forename: Chitaka
authors.initials: C
authors.lastname: Kasaoka
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D013274:Stomach Neoplasms / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D013312:Stress, Physiological / Q000150:complications*; D015996:Survival Rate; D013997:Time Factors