Langenbeck's Archives of Surgery

, Volume 397, Issue 5, pp 745–753 | Cite as

Non-curative gastric resection for patients with stage 4 gastric cancer—a single center experience and current review of literature

  • Yves Dittmar
  • Falk Rauchfuss
  • Max Goetz
  • Karin Jandt
  • Hubert Scheuerlein
  • Michael Heise
  • Utz Settmacher
Original Article



The majority of patients with gastric cancer present with an advanced stage and, therefore, may not be eligible for curative treatment. The role of non-curative gastric resection in situations other than emergency treatment for life threatening tumor-related complications is still under discussion.


Data from 290 consecutive patients with advanced gastric cancer who were treated in our hospital were analyzed. A total of 48 patients underwent primary non-curative gastric resection.


The overall survival in the non-curatively resected group was 15 months and 6 months for non-resected patients, respectively (p < 0.001). The incidence of tumor-related complications which required intervention was 63% in non-resected patients as compared to 12% in patients who underwent primary non-curative resection. Younger age, less than three tumor locations, and chemotherapy have been identified as prognostic factors for improved survival by univariate analysis. D3 lymph node involvement and chemotherapy were independent prognostic factors in the multivariate analysis. Peritoneal carcinosis did not significantly influence survival in resected patients. Non-curative resection in combination with chemotherapy resulted in longer overall survival than resection alone.


Primary non-curative gastric resection can reduce the incidence of severe tumor-related complications and can prolong overall survival in selected subgroups. In particular, younger patients with no more than two tumor locations should be considered for this procedure.

Key words

Non-curative gastric resection Chemotherapy Survival Gastric cancer 


  1. 1.
    Jemal A, Tiwari RC, Murray T, Ghafoor A, Samuels A, Ward E, Feuer EJ, Thun MJ (2004) Cancer statistics, 2004. CA Cancer J Clin 54(1):8–29PubMedCrossRefGoogle Scholar
  2. 2.
    Roukos DH, Kappas AM (2005) Perspectives in the treatment of gastric cancer. Nat Clin Pract Oncol 2(2):98–107. doi:10.1038/ncponc0099 PubMedCrossRefGoogle Scholar
  3. 3.
    Chu DZ, Lang NP, Thompson C, Osteen PK, Westbrook KC (1989) Peritoneal carcinomatosis in nongynecologic malignancy: a prospective study of prognostic factors. Cancer 63(2):364–367PubMedCrossRefGoogle Scholar
  4. 4.
    Feng XY, Chen YB, Chen S, Li YF, Zhou ZW, Li W, Zhan YQ, Sun XW, Xu DZ, Guan YX (2010) Relationship between the number of lymph node detection and prognosis in stage II( gastric cancer after D(2) dissection. Zhonghua Wei Chang Wai Ke Za Zhi 13(5):346–349PubMedGoogle Scholar
  5. 5.
    Hundahl SA, Phillips JL, Menck HR (2000) The National Cancer Data Base Report on poor survival of U.S. gastric carcinoma patients treated with gastrectomy: Fifth Edition American Joint Committee on Cancer staging, proximal disease, and the “different disease” hypothesis. Cancer 88(4):921–932. doi:10.1002/(SICI)1097-0142(20000215)88:4<921::AID-CNCR24>3.0.CO;2-SPubMedCrossRefGoogle Scholar
  6. 6.
    Coburn NG (2009) Lymph nodes and gastric cancer. J Surg Oncol 99(4):199–206. doi:10.1002/jso.21224 PubMedCrossRefGoogle Scholar
  7. 7.
    Kim MC, Kim HH, Jung GJ, Lee JH, Choi SR, Kang DY, Roh MS, Jeong JS (2004) Lymphatic mapping and sentinel node biopsy using 99mTc tin colloid in gastric cancer. Ann Surg 239(3):383–387PubMedCrossRefGoogle Scholar
  8. 8.
    Shah MA, Kelsen DP (2010) Gastric cancer: a primer on the epidemiology and biology of the disease and an overview of the medical management of advanced disease. J Natl Compr Canc Netw 8(4):437–447PubMedGoogle Scholar
  9. 9.
    Wagner AD, Unverzagt S, Grothe W, Kleber G, Grothey A, Haerting J, Fleig WE (2010) Chemotherapy for advanced gastric cancer. Cochrane Database Syst Rev 3:CD004064. doi:10.1002/14651858.CD004064.pub3
  10. 10.
    Nishiyama M, Wada S (2009) Docetaxel: its role in current and future treatments for advanced gastric cancer. Gastric Cancer 12(3):132–141. doi:10.1007/s10120-009-0521-z PubMedCrossRefGoogle Scholar
  11. 11.
    Meza-Junco J, Au HJ, Sawyer MB (2009) Trastuzumab for gastric cancer. Expert Opin Biol Ther 9(12):1543–1551. doi:10.1517/14712590903439702 PubMedCrossRefGoogle Scholar
  12. 12.
    Lawrence W Jr, Mc NG (1958) The effectiveness of surgery for palliation of incurable gastric cancer. Cancer 11(1):28–32PubMedCrossRefGoogle Scholar
  13. 13.
    ReMine WH (1979) Palliative operations for incurable gastric cancer. World J Surg 3(6):721–729PubMedCrossRefGoogle Scholar
  14. 14.
    Bozzetti F, Bonfanti G, Audisio RA, Doci R, Dossena G, Gennari L, Andreola S (1987) Prognosis of patients after palliative surgical procedures for carcinoma of the stomach. Surg Gynecol Obstet 164(2):151–154PubMedGoogle Scholar
  15. 15.
    Hartgrink HH, Putter H, Klein Kranenbarg E, Bonenkamp JJ, van de Velde CJ (2002) Value of palliative resection in gastric cancer. Br J Surg 89(11):1438–1443. doi:10.1046/j.1365-2168.2002.02220.x PubMedCrossRefGoogle Scholar
  16. 16.
    Lin SZ, Tong HF, You T, Yu YJ, Wu WJ, Chen C, Zhang W, Ye B, Li CM, Zhen ZQ, Xu JR, Zhou JL (2008) Palliative gastrectomy and chemotherapy for stage IV gastric cancer. J Cancer Res Clin Oncol 134(2):187–192. doi:10.1007/s00432-007-0268-z PubMedCrossRefGoogle Scholar
  17. 17.
    Huang KH, Wu CW, Fang WL, Chen JH, Lo SS, Wang RF, Li AF Palliative resection in noncurative gastric cancer patients. World J Surg 34 (5):1015-1021. doi:10.1007/s00268-010-0467-7
  18. 18.
    Miner TJ, Jaques DP, Karpeh MS, Brennan MF (2004) Defining palliative surgery in patients receiving noncurative resections for gastric cancer. J Am Coll Surg 198(6):1013–1021. doi:10.1016/j.jamcollsurg.2004.02.007S1072-7515(04)00149-8 PubMedCrossRefGoogle Scholar
  19. 19.
    Moehler M, Galle PR, Gockel I, Junginger T, Schmidberger H (2007) The multidisciplinary management of gastrointestinal cancer. Multimodal treatment of gastric cancer. Best Pract Res Clin Gastroenterol 21(6):965–981. doi:10.1016/j.bpg.2007.10.003 PubMedCrossRefGoogle Scholar
  20. 20.
    Lauren P (1965) The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. An attempt at a histo-clinical classification. Acta Pathol Microbiol Scand 64:31–49PubMedGoogle Scholar
  21. 21.
    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196. doi:10.1097/SLA.0b013e3181b13ca2 PubMedCrossRefGoogle Scholar
  22. 22.
    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(2):205–213PubMedCrossRefGoogle Scholar
  23. 23.
    Kunisaki C, Makino H, Takagawa R, Oshima T, Nagano Y, Fujii S, Otsuka Y, Akiyama H, Ono HA, Kosaka T, Ichikawa Y, Shimada H (2008) Impact of palliative gastrectomy in patients with incurable advanced gastric cancer. Anticancer Res 28(2B):1309–1315PubMedGoogle Scholar
  24. 24.
    Wang CS, Chao TC, Jan YY, Jeng LB, Hwang TL, Chen MF (2002) Benefits of palliative surgery for far-advanced gastric cancer. Chang Gung Med J 25(12):792–802PubMedGoogle Scholar
  25. 25.
    Sarela AI, Miner TJ, Karpeh MS, Coit DG, Jaques DP, Brennan MF (2006) Clinical outcomes with laparoscopic stage M1, unresected gastric adenocarcinoma. Ann Surg 243(2):189–195. doi:10.1097/01.sla.0000197382.43208.a500000658-200602000-00007 PubMedCrossRefGoogle Scholar
  26. 26.
    Meyer LRK, Meyer F, Gastinger I, Lippert H (2008) Qualitätssicherungsstudie zum Magenkarzinom in Deutschland. Der Onkologe 14:396–402. doi:10.1007/s00761-008-1340-2 CrossRefGoogle Scholar
  27. 27.
    Ouchi K, Sugawara T, Ono H, Fujiya T, Kamiyama Y, Kakugawa Y, Mikuni J, Yamanami H (1998) Therapeutic significance of palliative operations for gastric cancer for survival and quality of life. J Surg Oncol 69(1):41–44. doi:10.1002/(SICI)1096-9098(199809)69:1<41::AID-JSO8>3.0.CO;2-KPubMedCrossRefGoogle Scholar
  28. 28.
    Adachi Y, Aramaki M, Shiraishi N, Shimoda K, Yasuda K, Kitano S (1998) Long-term survival after perforation of advanced gastric cancer: case report and review of the literature. Gastric Cancer 1(1):80–83. doi:10.1007/s101209800024 PubMedCrossRefGoogle Scholar
  29. 29.
    Mizutani S, Shioya T, Maejima K, Yoshino M, Komine O, Bou H, Ogata M, Watanabe M, Shibuya T, Tokunaga A, Tajiri T (2007) Significance of gastrectomy as palliative surgery for gastric carcinoma with pyloric stenosis. J Nippon Med Sch 74(3):241–245CrossRefGoogle Scholar
  30. 30.
    Onate-Ocana LF, Mendez-Cruz G, Hernandez-Ramos R, Becker M, Carrillo JF, Herrera-Goepfert R, Aiello-Crocifoglio V, Ochoa-Carrillo F, Beltran-Ortega A (2007) Experience of surgical morbidity after palliative surgery in patients with gastric carcinoma. Gastric Cancer 10(4):215–220. doi:10.1007/s10120-007-0437-4 PubMedCrossRefGoogle Scholar
  31. 31.
    Lim S, Muhs BE, Marcus SG, Newman E, Berman RS, Hiotis SP (2007) Results following resection for stage IV gastric cancer; are better outcomes observed in selected patient subgroups? J Surg Oncol 95(2):118–122. doi:10.1002/jso.20328 PubMedCrossRefGoogle Scholar
  32. 32.
    Nazli O, Yaman I, Tansug T, Isguder AS, Bozdag AD, Bolukbasi H (2007) Palliative surgery for advanced stage (stage IV) gastric adenocarcinoma. Hepatogastroenterology 54(73):298–303PubMedGoogle Scholar
  33. 33.
    Saidi RF, ReMine SG, Dudrick PS, Hanna NN (2006) Is there a role for palliative gastrectomy in patients with stage IV gastric cancer? World J Surg 30(1):21–27. doi:10.1007/s00268-005-0129-3 PubMedCrossRefGoogle Scholar
  34. 34.
    Medina-Franco H, Contreras-Saldivar A, Ramos-De La Medina A, Palacios-Sanchez P, Cortes-Gonzalez R, Ugarte JA (2004) Surgery for stage IV gastric cancer. Am J Surg 187(4):543–546. doi:10.1016/j.amjsurg.2003.12.045 PubMedCrossRefGoogle Scholar
  35. 35.
    Monson JR, Donohue JH, McIlrath DC, Farnell MB, Ilstrup DM (1991) Total gastrectomy for advanced cancer. A worthwhile palliative procedure. Cancer 68(9):1863–1868PubMedCrossRefGoogle Scholar
  36. 36.
    Meijer S, De Bakker OJ, Hoitsma HF (1983) Palliative resection in gastric cancer. J Surg Oncol 23(2):77–80PubMedCrossRefGoogle Scholar
  37. 37.
    Yao Z, Mishra L (2009) Cancer stem cells and hepatocellular carcinoma. Cancer Biol Ther 8(18):1691–1698PubMedCrossRefGoogle Scholar
  38. 38.
    Tan S, Chen JS, Sun LJ, Yao HR (2009) Selective enrichment of hepatocellular cancer stem cells by chemotherapy. J Int Med Res 37(4):1046–1056PubMedGoogle Scholar
  39. 39.
    Mishra L, Banker T, Murray J, Byers S, Thenappan A, He AR, Shetty K, Johnson L, Reddy EP (2009) Liver stem cells and hepatocellular carcinoma. Hepatology 49(1):318–329. doi:10.1002/hep.22704 PubMedCrossRefGoogle Scholar
  40. 40.
    Koller M, Kussmann J, Lorenz W, Rothmund M (1994) Measuring quality of life in after-care of tumor surgery. Methods, problems and applications. Chirurg 65(4):333–339PubMedGoogle Scholar
  41. 41.
    Gilbertsen VA (1969) Results of treatment of stomach cancer. An appraisal of efforts for more extensive surgery and a rort of 1,983 cases. Cancer 23(6):1305–1308PubMedCrossRefGoogle Scholar
  42. 42.
    Yu D, Hung MC (2000) Overexpression of ErbB2 in cancer and ErbB2-targeting strategies. Oncogene 19(53):6115–6121. doi:10.1038/sj.onc.1203972 PubMedCrossRefGoogle Scholar
  43. 43.
    Dittmar Y, Posorski N, Rauchfuss F, Voigt R, Heise M, Jandt K, Gajda M, Settmacher U (2010) Relationship between degree of chromosomal aberration and survival in intestinal-type gastric cancer—a preliminary report based on three cases of hepatic metastasized gastric cancer with long-time survival. Onkologie 33(11):591–596. doi:10.1159/000321143 PubMedCrossRefGoogle Scholar
  44. 44.
    Sugarbaker PH, Yu W, Yonemura Y (2003) Gastrectomy, peritonectomy, and perioperative intraperitoneal chemotherapy: the evolution of treatment strategies for advanced gastric cancer. Semin Surg Oncol 21(4):233–248. doi:10.1002/ssu.10042 PubMedCrossRefGoogle Scholar
  45. 45.
    Glockzin G, Schlitt HJ, Piso P (2009) Peritoneal carcinomatosis: patients selection, perioperative complications and quality of life related to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. World J Surg Oncol 7:5. doi:10.1186/1477-7819-7-5 PubMedCrossRefGoogle Scholar
  46. 46.
    Iesalnieks I, Kullmann F, Dahlke M, Ghali N, Agha A, von Breitenbuch P, Schoelmerich J, Schlitt HJ, Piso P (2006) Surgical management of patients with peritoneal carcinomatosis of gastrointestinal origin. Z Gastroenterol 44(12):1237–1245. doi:10.1055/s-2006-927156 PubMedCrossRefGoogle Scholar
  47. 47.
    Jacquet P, Sugarbaker PH (1996) Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res 82:359–374PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Yves Dittmar
    • 1
  • Falk Rauchfuss
    • 1
  • Max Goetz
    • 1
  • Karin Jandt
    • 1
  • Hubert Scheuerlein
    • 1
  • Michael Heise
    • 1
  • Utz Settmacher
    • 1
  1. 1.Department of General, Visceral and Vascular SurgeryJena University HospitalJenaGermany

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