title: Does non-curative gastrectomy improve survival in patients with metastatic gastric cancer?
abstract: BACKGROUND
  The role of non-curative or palliative gastrectomy remains controversial. Our aim was to compare retrospective patients who have undergone non-curative gastrectomy to the patients with surgical exploration only.
  
  
  METHODS
  Between years 2000 and 2009, 488 patients with gastric adenocarcinoma were treated at the Department of Surgery, Helsinki University Central Hospital. Fifty-five patients had metastatic disease but their symptoms were not severe enough to require palliative surgery. Thirty-two of them underwent operative exploration (Group A), and 23 non-curative gastrectomy (Group B). All operations were initiated with curative intent.
  
  
  RESULTS
  The difference in median survival between Groups A and B was insignificant (5.7 months in Group A and 10.8 months in Group B, P = 0.152). However, 33 patients with postoperative chemotherapy had significantly better median survival than the others (14.2 months vs. 1.9 months, P < 0.001). No significant differences were observed between Groups A and B in the rate of late postoperative gastrointestinal obstruction or bleeding.
  
  
  CONCLUSIONS
  Non-curative gastrectomy does not improve survival in patients with metastatic gastric cancer, nor reduces the rate of late occlusions. There is no need for prophylactic palliative gastrectomy in patients with gastric cancer who do not have bleeding or obstruction preoperatively. Among those patients, postoperative chemotherapy seems to improve survival.
authors.affiliation: Department of Gastrointestinal Surgery, Helsinki University Central Hospital, Helsinki, Finland. arto.kokkola@hus.fi
authors.forename: Arto
authors.initials: A
authors.lastname: Kokkola
authors.forename: Johanna
authors.initials: J
authors.lastname: Louhimo
authors.forename: Pauli
authors.initials: P
authors.lastname: Puolakkainen
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D017024:Chemotherapy, Adjuvant; D005260:Female; D005387:Finland / Q000453:epidemiology; D005743:Gastrectomy / Q000379:methods*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome