title: Treatment of patients with stage IV gastric cancer.
abstract: OBJECTIVE
  Treatment of patients with stage IV gastric cancer is controversial. This study was retrospectively designed to elucidate the best treatment for these patients.
  
  
  METHODS
  Between 2003 and 2010, a total of 558 patients with gastric cancer were treated at the Department of Surgery, Tottori University Hospital, 96 (17.2 %) of whom were diagnosed with stage IV. Among 96, 54 underwent palliative gastrectomy while 42 underwent chemotherapy, exploratory laparotomy, or gastrojejunostomy for unresectable cases. Surgical morbidity, mortality, and patient survival were analyzed with respect to several factors.
  
  
  RESULTS
  Among resected cases, high age, R2 operation, and neoadjuvant chemotherapy did not increase the occurrence of postoperative complications. Patient age, R1 operation, and sufficient chemotherapy were indicated as better prognostic factors for resected stage IV gastric cancers. Even after R2 operation, continuous chemotherapy with changing regimens prolonged R2 resected patients' survival to 25 months (mean). In unresectable cases, bypass operation did not affect patients' survival. But, chemotherapy with changing regimens prolonged the survival of unresectable cases.
  
  
  CONCLUSIONS
  Adequate management can resolve surgery-related morbidity, and continuous chemotherapy may be one of the most important prognostic factors in stage IV gastric cancer.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago 683-8504, Japan. masaike@med.tottori-u.ac.jp
authors.forename: Masahide
authors.initials: M
authors.lastname: Ikeguchi
authors.forename: Abdul
authors.initials: A
authors.lastname: Kader
authors.forename: Seigo
authors.initials: S
authors.lastname: Takaya
authors.forename: Youji
authors.initials: Y
authors.lastname: Fukumoto
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Osaki
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Saito
authors.forename: Shigeru
authors.initials: S
authors.lastname: Tatebe
authors.forename: Toshiro
authors.initials: T
authors.lastname: Wakatsuki
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D013505:Digestive System Surgical Procedures / Q000379:methods; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents