Gastrectomy in advanced gastric cancer effectively palliates symptoms and may improve survival in select patients.
BACKGROUND
The role of gastrectomy in the face of incurable gastric cancer is evolving. We sought to evaluate our experience with incomplete (i.e., R2) gastrectomy in advanced gastric cancer.


METHODS
We reviewed 210 locally advanced or metastatic gastric cancers (1992-2008). Patient characteristics and outcomes were compared between three groups: gastrectomy (N = 99), exploration without resection (N = 66), and no surgery (N = 45).


RESULTS
Clinicopathologic characteristics were similar between groups. Symptoms successfully resolved after gastrectomy in 48 % with a complication rate of 32 % and mortality of 6 %. Overall median survival for all patients was 6.2 months: 10.0 months after gastrectomy, 4.1 months after exploration without resection, and 5.3 months for no surgery (p < 0.001). Perioperative complications were the only predictor of symptom resolution following resection (OR = 0.175). Resolution of symptoms (p < 0.001, Hazards Ratio (HR) = 0.09) and preoperative nausea/vomiting (p = 0.017, HR = 0.55) improved survival, while linitis plastica (p = 0.035, HR = 4.05) and spindle cell morphology (p = 0.011, HR = 1.98) were predictors of poor survival in patients undergoing resection.


CONCLUSIONS
Gastrectomy in the setting of advanced gastric cancer may be useful in up to half of patients with an acceptable perioperative mortality rate. Symptom resolution offers a potential survival advantage but is dependent upon a complication-free course, so should only be considered selectively.
Amy
A
Collins
Ioannis
I
Hatzaras
Carl
C
Schmidt
Katherine
K
Carruthers
W Scott
WS
Melvin
Pete
P
Muscarella
E Christopher
EC
Ellison
Edward
E
Martin
Mark
M
Bloomston
D015746:Abdominal Pain / Q000209:etiology / Q000601:surgery; D057868:Anastomotic Leak / Q000209:etiology; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000401:mortality; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D009325:Nausea / Q000209:etiology / Q000601:surgery; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D010166:Palliative Care; D013274:Stomach Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D014839:Vomiting / Q000209:etiology / Q000601:surgery; D015431:Weight Loss