title: Does surgery have a role in managing incurable gastric cancer?
abstract: Although the incidence of gastric cancer is decreasing, the outcomes of this disease are among the poorest of all solid-organ tumours, predominantly due to the frequent presence of stage IV metastatic disease at primary presentation. Stage IV gastric cancer is incurable and carries a very poor prognosis (5-year survival rate of ∼4%); palliative chemotherapy remains the standard of care, but increasing evidence indicates that palliative surgery can provide a prognostic and symptomatic benefit, particularly in combination with chemotherapy and/or radiotherapy. Ongoing prospective trials should further clarify the efficacy of palliative surgery in comparison with other treatment modalities. Until such data are available, surgery should not be offered as a standard first-line treatment, but can be considered in selected cases after thorough multidisciplinary discussions involving the patient. Patient selection for both gastrectomy and nonresectional surgery must include consideration of various factors that predict quality of life after surgery. This Perspectives summarizes the available evidence and discusses the utility of palliative surgery in relation to other therapeutic modalities in the management of incurable gastric cancer.
authors.affiliation: Department of Surgery, Royal Marsden NHS Foundation Trust London and Surrey, Fulham Road, London SW3 6JJ, UK.
authors.forename: Sri G
authors.initials: SG
authors.lastname: Thrumurthy
authors.affiliation: Department of Surgery, Royal Marsden NHS Foundation Trust London and Surrey, Fulham Road, London SW3 6JJ, UK.
authors.forename: M Asif
authors.initials: MA
authors.lastname: Chaudry
authors.affiliation: Department of Medicine, Royal Marsden NHS Foundation Trust London and Surrey, Fulham Road, London SW3 6JJ, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Chau
authors.affiliation: Department of Surgery, Royal Marsden NHS Foundation Trust London and Surrey, Fulham Road, London SW3 6JJ, UK.
authors.forename: William
authors.initials: W
authors.lastname: Allum
mesh_terms: D006801:Humans; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D010166:Palliative Care; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis