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World Journal of Surgery

, Volume 13, Issue 5, pp 617–621 | Cite as

The survival benefit of resection in patients with advanced stomach cancer: The norwegian multicenter experience

  • Trond Haugstvedt
  • Asgaut Viste
  • Geir Egil Eide
  • Odd Söreide
  • Members of the Norwegian Stomach Cancer Trial
Original Scientific Reports

Abstract

Five hundred three of 1,165 patients with stomach cancer included in a national multicenter study received noncurative treatment. This study elucidates whether a palliative resection offered any survival advantage compared to nonresectional treatment. One hundred eighty-two (36%) of 503 patients had gastric resection (including total gastrectomy in 64 patients), 70 (14%) had a bypass procedure, and an exploratory laparotomy was carried out in 156 (31%). Seventy-eight patients (16%) were not subjected to surgery. Resection carried the same postoperative mortality rate as a nonresectional procedure (13% versus 12%). Univariate survival analysis demonstrated that median survival and 1- and 2-year survival rates were significantly higher in resected patients; however, as basic patient characteristics (age, stage, etc.) differed between the 2 main treatment groups, survival and factors affecting survival were analyzed using the Cox proportional hazards model. Given similar age and preoperative weight loss, resection doubled median survival both for stage III disease (9 versus 4.5 mo) and for stage IV disease (6 versus 3 mo) compared to nonresection or no operation. In conclusion, resection seems justified in patients with advanced stomach cancer since a survival benefit is documented.

Keywords

Stomach Cancer Gastric Resection Mese Preoperative Weight Palliative Resection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Cette étude multicentrique nationale concerne 503 des 1,165 patients ayant un cancer gastrique traité de façon palliative. Son but était de déterminer si la résection palliative présentait des avantages par rapport à un traitement ne comportant pas de résection. Cent quatre vingt deux des 503 patients (36%) ont eu une résection chirurgicale (y compris 64 gastrectomies totales), 70 (14%) ont eu une dérivation, et 156 (31%) n'ont eu qu'une laparotomie exploratrice. Soixante dix huit patients (16%) n'ont pas eu de chirurgie. Les résections avaient le même taux de mortalité que les techniques sans résection (13% versus 12%). L'analyse unifactorielle a montré que la survie médiane, à 1 et à 2 ans, était supérieure chez les patients ayant eu une résection. Cependant, comme les groupes n'étaient pas comparables, la survie et les facteurs influençant la survie ont été analysés selon le modèle de Cox. A âge et à perte de poids préopératoire égaux, la résection a doublé la survie médiane pour les patients ayant un cancer stade III (9 versus 4.5 mois) et stade IV (6 versus 3 mois) par rapport à ceux qui n'ont pas eu de résection ou d'opération. En conclusion, la résection semble se justifier chez des patients ayant un cancer gastrique avancé car la survie est augmentée.

Resumen

Quinientos tres de 1,165 pacientes con cáncer de estómago incluidos en un estudio nacional multicéntrico recibieron tratamiento no curativo. El presente estudio dilucida si una resección paliativa ofrece alguna ventaja en sobrevida en comparación con un procedimiento no reseccional. Ciento ochenta y dos (36%) de 503 pacientes fueron sometidos a resección gástrica (incluso gastrectomía total en 64 pacientes), 70 (14%) a un procedimiento de anastomosis derivativa, y 156 (31%) a laparotomía exploratoria. Setenta y ocho (16%) no fueron operados. Las resecciones exhibieron las mismas tasas de mortalidad postoperatoria que los procedimientos no reseccionales (13% versus 12%). El análisis univariable de supervivencia demostró que la supervivencia media y las tasas de sobrevida a 1 y 2 años fueron significativamente mayores en los pacientes resecados. Sinembargo, al considerar que las características básicas de los pacientes (edad, estadio, etc.) eran diferentes en los 2 grupos principales, se analizaron tanto la supervivencia como los factures que afectan la sobrevida mediante el modelo de Cox de riesgos relativos. Con edad y pérdida preoperatoria de peso similares, la resección dobló la supervivencia media para los pacientes con enfermedad en estadio III (9 versus 4.5 meses) y con enfermedad en estadio IV (6 versus 3 meses), en comparación con los procedimientos no reseccionales o con la no intervención. En conclusión, la resección aparece justificada en pacientes con cáncer de estómago avanzado puesto que se ha documentado un beneficio en cuanto a supervivencia.

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Copyright information

© Société Internationale de Chirurgie 1989

Authors and Affiliations

  • Trond Haugstvedt
    • 1
    • 2
  • Asgaut Viste
    • 1
    • 2
  • Geir Egil Eide
    • 1
    • 2
  • Odd Söreide
    • 1
    • 2
  • Members of the Norwegian Stomach Cancer Trial
    • 1
  1. 1.Department of Surgery, and Section for Medical Informatics and StatisticsUniversity of BergenBergenNorway
  2. 2.Norwegian Stomach Cancer TrialNorway

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