A systematic review of surgery for non-curative gastric cancer
- Alyson L. MaharAffiliated withSunnybrook Research Institute, Sunnybrook Health Sciences CentreDepartment of Community Health and Epidemiology, Queen’s University
- , Natalie G. CoburnAffiliated withSunnybrook Research Institute, Sunnybrook Health Sciences CentreDivision of Surgical Oncology, Sunnybrook Health Sciences Centre and Odette Cancer Centre Email author
- , Simron SinghAffiliated withDepartment of Medical Oncology/Hematology, Sunnybrook Health Sciences Centre and Odette Cancer Centre
- , Calvin LawAffiliated withDivision of Surgical Oncology, Sunnybrook Health Sciences Centre and Odette Cancer Centre
- , Lucy K. HelyerAffiliated withDepartment of Surgery, Dalhousie University
Most gastric cancer patients present with advanced stage disease precluding curative surgical treatment. These patients may be considered for palliative resection or bypass in the presence of major symptoms; however, the utility of surgery for non-curative, asymptomatic advanced disease is debated and the appropriate treatment strategy unclear.
To evaluate the non-curative surgical literature to better understand the limitations and benefits of non-curative surgery for advanced gastric cancer.
A literature search for non-curative surgical interventions in gastric cancer was conducted using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases from 1 January 1985 to 1 December 2009. All abstracts were independently rated for relevance by a minimum of two reviewers. Outcomes of interest were procedure-related morbidity, mortality, and survival.
Fifty-nine articles were included; the majority were retrospective, single institution case series. Definitions describing the treatment intent for gastrectomy were incomplete in most studies. Only five were truly performed with relief of symptoms as the primary indication for surgery, while the majority were considered non-curative or not otherwise specified. High rates of procedure-related morbidity and mortality were demonstrated for all surgeries across the majority of studies and treatment-intent categories. Median and 1-year survival were poor, and values ranged widely within surgical approaches and across studies.
A lack of transparent documentation of disease burden and symptoms limits the surgical literature in non-curative gastric cancer. Improved survival is not evident for all patients receiving non-curative gastrectomy. Further prospective research is required to determine the optimal intervention for palliative gastric cancer patients.
KeywordsAdvanced disease Non-curative Palliative Surgery
- A systematic review of surgery for non-curative gastric cancer
Volume 15, Issue 1 Supplement, pp 125-137
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- Author Affiliations
- 1. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- 2. Department of Community Health and Epidemiology, Queen’s University, Kingston, Canada
- 3. Division of Surgical Oncology, Sunnybrook Health Sciences Centre and Odette Cancer Centre, Suite T2-60, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
- 5. Department of Medical Oncology/Hematology, Sunnybrook Health Sciences Centre and Odette Cancer Centre, Toronto, Canada
- 6. Department of Surgery, Dalhousie University, Halifax, Canada