title: Metastatic gastric cancer (MGC) patients: Can we improve survival by metastasectomy? A systematic review and meta-analysis.
abstract: BACKGROUND
  Prognosis with current management strategies continues to be dismal in metastatic gastric cancer (MGC) patients. We aimed to evaluate the role of metastasectomy in improving survival.
  
  
  METHODS
  A comprehensive search of MEDLINE, EMBASE, SCOPUS, and Cochrane central databases (1965 to present) was performed. All comparative studies measuring survival in MGC patients undergoing metastasectomy versus other therapies were included. Pooled risk ratios with corresponding 95% confidence intervals (CI) were calculated for survival at 1, 3, and 5 years.
  
  
  RESULTS
  Sixteen studies with 1712 patients (378 patients in metastasectomy, 1334 patients in other therapies) were eligible for the final meta-analysis. Median age was 63 years. For patients undergoing metastasectomy, a significant survival advantage was observed at 1 year (RR 0.52, CI 0.43-0.62), 3 year (RR 0.75 CI 0.67-0.83), and 5 year (RR 0.82, CI 0.74-0.91); mean increased difference in survival conferred by metastasectomy averaged between 9.3 and 15.7 months; P < 0.001 for all results. Age, ECOG status, and STROBE score did not contribute to differences in survival.
  
  
  CONCLUSIONS
  Metastasectomy is associated with increased survival at 1, 3, and 5 years in MGC patients. Large prospective randomized controlled trials are critically needed to evaluate the role of metastasectomy in MGC.
authors.affiliation: Division of Surgical Oncology at Department of Surgery, University of Miami-Miller School of Medicine, Miami, Florida.|Department of Internal Medicine, University of Miami-Miller School of Medicine, Miami, Florida.
authors.forename: Rahul
authors.initials: R
authors.lastname: Gadde
authors.affiliation: Department of Internal Medicine, University of Miami-Miller School of Medicine, Miami, Florida.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Tamariz
authors.affiliation: Division of Surgical Oncology at Department of Surgery, University of Miami-Miller School of Medicine, Miami, Florida.
authors.forename: Mena
authors.initials: M
authors.lastname: Hanna
authors.affiliation: Division of Surgical Oncology at Department of Surgery, University of Miami-Miller School of Medicine, Miami, Florida.|Sylvester Comprehensive Cancer Center, University of Miami-Miller School of Medicine, Miami, Florida.
authors.forename: Eli
authors.initials: E
authors.lastname: Avisar
authors.affiliation: Division of Surgical Oncology at Department of Surgery, University of Miami-Miller School of Medicine, Miami, Florida.|Sylvester Comprehensive Cancer Center, University of Miami-Miller School of Medicine, Miami, Florida.
authors.forename: Alan
authors.initials: A
authors.lastname: Livingstone
authors.affiliation: Division of Surgical Oncology at Department of Surgery, University of Miami-Miller School of Medicine, Miami, Florida.|Sylvester Comprehensive Cancer Center, University of Miami-Miller School of Medicine, Miami, Florida.
authors.forename: Dido
authors.initials: D
authors.lastname: Franceschi
authors.affiliation: Division of Surgical Oncology at Department of Surgery, University of Miami-Miller School of Medicine, Miami, Florida.|Sylvester Comprehensive Cancer Center, University of Miami-Miller School of Medicine, Miami, Florida.
authors.forename: Danny
authors.initials: D
authors.lastname: Yakoub
mesh_terms: D006801:Humans; D059146:Metastasectomy / Q000401:mortality*; D011379:Prognosis; D013274:Stomach Neoplasms / Q000401:mortality* / Q000556:secondary*; D015996:Survival Rate
keywords: liver metastasis; metastasectomy; metastatic gastric cancer; neoplasm metastasis; stomach neoplasm; survival rate