Survival benefits of palliative gastric cancer resection - a regional center experience.
OBJECTIVE
In regions where screening programs are not widespread, the high number of patients with advanced gastric cancer remains a serious problem to the surgeon. Palliative resection remains debatable and has been considered irrelevant to the outcome. However, its role is widely accepted for palliation of symptoms and some series reported survival benefits.


METHODS
Retrospective study including 155 patients with gastric cancer operated during 10 years. Clinicopathologic data, morbimortality and survival were registered and a detailed analysis performed for palliative cases.


RESULTS
This series included 90 curative and 40 palliative resections; 25 had other palliative procedures. 40.5% presented in stage IV. In palliative group, complications occurred in 22.5% after resection (vs. 16% in non-resection, p=0.524), with a lower postoperative mortality (7.5 vs. 24%, p=0.051). First year survival rate was better after palliative resection and in patients with locally advanced disease without distant metastasis it had a clear impact in the survival curve (log-rank test p=0.043). This benefit was not present on a long-term basis.


CONCLUSIONS
Palliative resections definitely improved short-term survival, without significantly increasing postoperative morbimortality. However, this was evident only for patients with locally advanced but not for metastatic disease. Multi-centric prospective trials are still missing.
Department of General Surgery, Hospital Divino Espirito Santo, Ponta Delgada, Portugal. luis_v_amaral@sapo.pt
Luis
L
Amaral
Joana
J
Mendes
Pedro
P
Martins
Luís
L
Bernardo
Rui
R
Quintanilha
Victor
V
Santos
António Silva
AS
Melo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010166:Palliative Care; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D014839:Vomiting / Q000209:etiology; D015431:Weight Loss