Experience of surgical morbidity after palliative surgery in patients with gastric carcinoma.
BACKGROUND
Indications for palliative surgery in gastric carcinoma (GC) are controversial. Our aim was to describe the results of palliative surgery in GC in terms of operative morbidity and survival.


METHODS
We conducted a retrospective cohort study of patients with GC, who were divided into three groups: resection with microscopic residual disease (R1), palliative resection with macroscopic residual disease (R2), and gastrojejunostomy. Comparisons were tested with analysis of variance (ANOVA) or chi(2) test, and the Kaplan-Meier method was used for survival analysis.


RESULTS
One hundred and thirty-two patients were included in the study: 21 had R1, 71 had R2, and 40 had gastrojejunostomy. Surgical morbidity was recorded in 4 patients (19%), 23 patients (32.4%), and 1 patient (2.5%) in each of the three groups, respectively (P = 0.001). Operative mortality occurred in 6 patients (8.5%) from the R2 group and in 1 (2.5%) patient from the gastrojejunostomy group (P = 0.406). Median survivals of the R1, R2, and gastrojejunostomy groups were 22.8 months (95% confidence interval [CI], 16.4-29.3), 12.4 (95% CI, 9.01-15.8) months, and 6.4 months (95% CI, 0-14.6), respectively (P = 0.078)


CONCLUSIONS
R1 resections and gastrojejunostomy were associated with low surgical morbidity and mortality, unlike R2 resection; in this group, surgical morbidity and mortality was high. Therefore, the benefit of palliative resection in the presence of extensive residual disease should be balanced against the risk of surgical morbidity.
Oñate-Ocaña
Luis F
LF
Clinica de Neoplasias Gástricas, Departamento de Gastroenterología, Instituto Nacional de Cancerología, San Fernando 22, Colonia Sección XVI, Tlalpan, D.F., 14080, Mexico City, Mexico.
Méndez-Cruz
Guadalupe
G
Hernández-Ramos
Roberto
R
Becker
Mauricio
M
Carrillo
José F
JF
Herrera-Goepfert
Roberto
R
Aiello-Crocifoglio
Vincenzo
V
Ochoa-Carrillo
Francisco
F
Beltrán-Ortega
Arturo
A
D000230:Adenocarcinoma / Q000453:epidemiology / Q000601:surgery; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000401:mortality; D015390:Gastric Bypass / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008297:Male; D008800:Mexico; D008875:Middle Aged; D009017:Morbidity; D010166:Palliative Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000601:surgery*; D016019:Survival Analysis