title: The impact and optimal indication of non-curative gastric resection for stage IV advanced gastric cancer diagnosed during surgery: 10 years of experience at a single institute.
abstract: BACKGROUND
  The survival benefit of non-curative gastric resection for patients with stage IV gastric cancer is still unclear.
  
  
  METHODS
  Of the patients who underwent open abdominal surgery that was preoperatively intended to be a radical excision procedure for gastric cancer, 72 were diagnosed with stage IV during the operation. At this institution, non-curative gastric resection is performed whenever possible.
  
  
  RESULTS
  Non-curative gastric resection was performed in 44 of the 72 patients. According to the survival analysis, the median survival times in the gastric resection and no-resection groups were 1.9 and 0.9 years, respectively (log-rank test, p = 0.014). Based on the multivariate analysis, we selected gastric resection (hazard ratio [HR] = 0.309; 95% confidence interval [CI] = 0.152-0.615) and postoperative chemotherapy (HR = 0.136; 95% CI = 0.056-0.353) as independent factors associated with overall survival (OS). In the subgroup analyses of OS, the factors that were associated with gastric resection having no survival benefit were the existence of distant lymph node or liver metastasis (p = 0.527) and the lack of postoperative chemotherapy (p = 0.589).
  
  
  CONCLUSIONS
  For patients who have distant lymph node or liver metastasis and those who will not undergo postoperative chemotherapy, non-curative gastric resection has no survival benefit.
authors.affiliation: Department of Surgery, Asahi General Hospital, 1326 I, Asahi-shi, Chiba, 289-2511, Japan. yn708@jichi.ac.jp.
authors.forename: Naoya
authors.initials: N
authors.lastname: Yamada
authors.affiliation: Department of Surgery, Asahi General Hospital, 1326 I, Asahi-shi, Chiba, 289-2511, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Akai
authors.affiliation: Department of Surgery, Asahi General Hospital, 1326 I, Asahi-shi, Chiba, 289-2511, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Nomura
authors.affiliation: Department of Surgery, Asahi General Hospital, 1326 I, Asahi-shi, Chiba, 289-2511, Japan.
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Tanaka
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult
keywords: Non-curative gastric resection; Postoperative chemotherapy; Stage IV gastric cancer