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Role of Palliative Resection in Patients with Incurable Advanced Gastric Cancer Who are Unfit for Chemotherapy

  • Hayato Omori
  • Yutaka Tanizawa
  • Rie Makuuchi
  • Tomoyuki Irino
  • Etsuro Bando
  • Taiichi Kawamura
  • Masanori Terashima
Original Scientific Report (including Papers Presented at Surgical Conferences)
  • 17 Downloads

Abstract

Background

The REGATTA trial showed that gastrectomy followed by chemotherapy for advanced gastric cancer with a single non-curable factor did not improve survival outcomes in comparison with chemotherapy alone. Chemotherapy is therefore the mainstay treatment for incurable gastric cancer. However, for patients who are unfit for chemotherapy, the role of palliative gastrectomy remains controversial.

Methods

We retrospectively identified 207 patients with in curable gastric cancer who underwent palliative gastrectomy or bypass surgery because of urgent symptoms who were treated from 2002 to 2014. Fifty-nine of these patients who did not receive chemotherapy following surgery were enrolled in the present study. The patients were divided into the palliative gastrectomy group (n = 40) and the bypass surgery group (n = 19). The survival outcomes of the two groups were compared. Independent prognostic factors were identified using multivariate analysis.

Results

The rate of patients who underwent gastrectomy was significantly higher among patients whose tumors were located in the upper third (n = 19/20, 95%) than in patients whose tumors were located in the lower or middle third (n = 21/39, 54%, p = 0.001). The median survival time (MST) in the gastrectomy group (145 days) was significantly longer than that in the bypass group (86 days) (p = 0.008). Bypass surgery was identified as an independent prognostic factor in the multivariate analysis (HR = 2.3; 95%CI = 1.3–4.2 p = 0.007).

Conclusions

Palliative gastrectomy may improve survival in patients with incurable gastric cancer who show emergent symptoms and who are unfit for chemotherapy.

References

  1. 1.
    Koizumi W, Narahara H, Hara T et al (2008) S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol 9:215–221CrossRefGoogle Scholar
  2. 2.
    Boku N, Yamamoto S, Fukuda H et al (2009) Fluorouracil versus combination of irinotecan plus cisplatin versus S-1 in metastatic gastric cancer: a randomized phase 3 study. Lancet Oncol 10:1063–1069CrossRefGoogle Scholar
  3. 3.
    Bang YJ, Van Cutsem E, Feyereislova A et al (2010) Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomized controlled trial. Lancet 376:687–697CrossRefGoogle Scholar
  4. 4.
    Hartgrink HH, Putter H, Klein Kranenbarg E et al (2002) Value of palliative resection in gastric cancer. Br J Surg 89:1438–1443CrossRefGoogle Scholar
  5. 5.
    Huang KH, Wu CW, Fang WL et al (2010) Palliative resection in noncurative gastric cancer patients. World J Surg 34:1015–1021.  https://doi.org/10.1007/s00268-010-0467-7 CrossRefPubMedGoogle Scholar
  6. 6.
    Mariette C, Bruyere E, Messager M et al (2013) Palliative resection for advanced gastric and junctional adenocarcinoma: which patients will benefit from surgery? Ann Surg Oncol 20:1240–1249CrossRefGoogle Scholar
  7. 7.
    Keranen I, Kylanpaa L, Udd M et al (2013) Gastric outlet obstruction in gastric cancer: a comparison of three palliative methods. J Surg Oncol 108:537–541CrossRefGoogle Scholar
  8. 8.
    Yang K, Liu K, Zhang WH et al (2015) The value of palliative gastrectomy for Gastric cancer patients with intraoperatively proven peritoneal seeding. Medicine (Baltimore) 94:e1051CrossRefGoogle Scholar
  9. 9.
    Saidi RF, ReMine SG, Dudrick PS et al (2006) Is there a role for palliative gastrectomy in patients with stage IV gastric cancer? World J Surg 30:21–27.  https://doi.org/10.1007/s00268-005-0129-3 CrossRefPubMedGoogle Scholar
  10. 10.
    Chang YR, Han DS, Kong SH et al (2012) The value of palliative gastrectomy in gastric cancer with distant metastasis. Ann Surg Oncol 19:1231–1239CrossRefGoogle Scholar
  11. 11.
    Fujitani K, Yang HK, Mizusawa J et al (2016) Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomized controlled trial. Lancet Oncol 17:309–318CrossRefGoogle Scholar
  12. 12.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefGoogle Scholar
  13. 13.
    Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma—2nd English edition. Gastric Cancer 1:10–24CrossRefGoogle Scholar
  14. 14.
    Adler DG, Baron TH (2002) Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 97:72CrossRefGoogle Scholar
  15. 15.
    Sano T, Sasako M, Yamamoto S et al (2004) Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy—Japan Clinical Oncology Group study 9501. J Clin Oncol 22:2767–2773CrossRefGoogle Scholar
  16. 16.
    Sano T, Sasako M, Mizusawa J et al (2017) Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma. Ann Surg 265:277–283CrossRefGoogle Scholar
  17. 17.
    Onate-Ocana LF, Mendez-Cruz G, Hernandez-Ramos R et al (2007) Experience of surgical morbidity after palliative surgery in patients with gastric carcinoma. Gastric Cancer 10:215–220CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Hayato Omori
    • 1
  • Yutaka Tanizawa
    • 1
  • Rie Makuuchi
    • 1
  • Tomoyuki Irino
    • 1
  • Etsuro Bando
    • 1
  • Taiichi Kawamura
    • 1
  • Masanori Terashima
    • 1
  1. 1.Division of Gastric SurgeryShizuoka Cancer CenterSunto-gunJapan

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