Journal of Cancer Research and Clinical Oncology

, Volume 134, Issue 2, pp 187–192 | Cite as

Palliative gastrectomy and chemotherapy for stage IV gastric cancer

  • Sheng-Zhang Lin
  • Hong-Fei Tong
  • Tao You
  • Yao-Jun Yu
  • Wei-Jun Wu
  • Cong Chen
  • Wei Zhang
  • Bing Ye
  • Chun-Ming Li
  • Zhi-Qiang Zhen
  • Jia-Rong Xu
  • Jun-Liang Zhou
Original Paper

Abstract

Purpose

To investigate the value of palliative gastrectomy and chemotherapy in a large series of patients with stage IV gastric cancer.

Methods

A total of 389 patients were identified in survival analysis. Among which, 183 cases received palliative gastrectomy (PG) and 206 cases received unresectable operation, 184 cases received palliative chemotherapy (PC) and 205 cases did not receive chemotherapy. The survival advantages of patients, based on treatments modality, were also analyzed in patients with liver metastasis, peritoneal dissemination and lymph node metastasis.

Results

The 1-year, 3-year, 5-year survival rate of those patients who were treated with PG + PC were 85.7% (96/112), 32.1% (36/112), and 8.9% (10/112), which were far better than those who were not. For those patients with liver metastasis, peritoneal dissemination, and/or N3 lymph node metastasis, survival advantages were also present if treated with this multimodality approach.

Conclusion

The survival time and palliative duration were significantly longer in patients after PG than after non-resection operations. Postoperative chemotherapy prolonged the survival time of patients after palliative surgery. PG combined with adjuvant chemotherapy may improve survival in patients with stage IV gastric cancer, even with liver metastasis, peritoneal dissemination, and lymph node metastasis.

Keywords

Gastric cancer Surgery Chemotherapy 

Abbreviations

PG

Palliative gastrectomy

PC

Palliative chemotherapy

UO

Unresectable operation

NC

No chemotherapy

DFS

Disease-free survival

OS

Overall survival

Reference

  1. AJCC (2003) Cancer staging manual, 6th edn, Springer, New YorkGoogle Scholar
  2. Doglietto GB, Pacelli F, Caprino P, Alfieri S, Carriero C, Malerba M, Crucitti (1999) Palliative surgery for far-advanced gastric cancer: a retrospective study on 305 consecutive patients. Am Surg 65:352–355PubMedGoogle Scholar
  3. Kakeji Y, Maehara Y, Tomoda M, Kabashima A, Ohmori M, Oda S, Ohno S, Sugimachi K (1998) Long-term survival of patients with stage IV gastric carcinoma. Cancer 82:2307–2311PubMedCrossRefGoogle Scholar
  4. Kodera Y, Yamamura Y, Shimizu Y, Torii A, Hirai T, Yasui K, Morimoto T, Kato T, Kito T (1997) Metastatic gastric lymph node rate is a significant prognostic factor for resectable stage IV stomach cancer. J Am Coll Surg 185:65–69PubMedGoogle Scholar
  5. Lawrence W Jr, McNeer G (1958) The effectiveness of surgery for palliation of incurable gastric cancer. Cancer 11:28–32PubMedCrossRefGoogle Scholar
  6. Maehara Y, Moririguchi S, Kakeji S, Kohnoue S, Korenaga D, Haraguchi M, Sugimachi K (1991) Pertinent risk factors and gastric carcinoma with synchronous peritoneal dissemination or liver metastasis. Surgery 110:820–823PubMedGoogle Scholar
  7. 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 187:543–546PubMedCrossRefGoogle Scholar
  8. Miner TJ, Karpeh MS (2004) Gastrectomy for gastric cancer: defining critical elements of patient selection and outcome assessment. Surg Oncol Clin N Am 13:455–466PubMedCrossRefGoogle Scholar
  9. Miyazaki M, Itoh H, Nakagawa K, Ambiru S, Shimizu H, Togawa A, Shiobara M, Ohtuska M, Sasada K, Shimizu Y, Yoshioka S, Nakajima N, Suwa T, Kimura F (1997) Hepatic resection of liver metastases from gastric cancer. Am J Gastroenterol 62:490–493Google Scholar
  10. Monson JR, Donohue JH, McIlrath DC, Farnell MB, Ilstrup DM (1991) Total gastrectomy for advanced cancer. A worthwhile palliative procedure. Cancer 68:1863–1868PubMedCrossRefGoogle Scholar
  11. Ohno S, Maeta M, Oka A, Hirooka Y, Baba H, Furusawa M (1994) Peritoneal dissemination after a curative gastrectomy in patients with undifferentiated adenocarcinoma of the stomach. Semin Surg Oncol 10:117–120PubMedCrossRefGoogle Scholar
  12. Otani S, Maeta M, Oka A, Hirooka Y, Tsujitani S, Ikeguchi M, Harnazoe R, Kaibara N (1995) Long-term survival of 5 years following initial surgery for gastric cancer and simultaneous disseminated peritoneal metastasis: report of a case. Surg Today 25:959–961PubMedCrossRefGoogle Scholar
  13. 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 69:41–44PubMedCrossRefGoogle Scholar
  14. Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108PubMedCrossRefGoogle Scholar
  15. Sarela AI, Miner TJ, Jaques DP, Karpeh MS, Brennan MF (2004) Outcomes for patients with laparoscopically staged M1 gastric adenocarcinoma. Br J Surg 91:514–520CrossRefGoogle Scholar
  16. Sastre J, Garcia-Saenz JA, Diaz-Rubio E (2006) Chemotherapy for gastric cancer. World J Gastroenterol 12:204–213PubMedGoogle Scholar
  17. Swan R, Miner TJ (2006) Current role of surgical therapy in gastric cancer. World J Gastroenterol 12:372–379PubMedGoogle Scholar
  18. Takeno S, Noguchi T, Kikuchi R, Sato T, Uchida Y, Yokoyama S (2001) Analysis of the survival period in resectable stage IV gastric cancer. Ann Surg Oncol 8:215–221PubMedCrossRefGoogle Scholar
  19. Wang JY, Hsieh JS, Huang CJ, Huang YS, Huang TJ (1996) Clinicopathologic study of advanced gastric cancer without serosal invasion in young and old patients. J Surg Oncol 63:36–40PubMedCrossRefGoogle Scholar
  20. Wohrer SS, Raderer M, Hejna M (2004) Palliative chemotherapy for advanced gastric cancer. Ann Oncol 15:1585–1595PubMedCrossRefGoogle Scholar
  21. Yang L, Parkin DM, Ferlay J, Li L, Chen Y (2005) Estimates of cancer incidence in China for 2000 and projections for 2005. Cancer Epidemiol Biomarkers Prev 14:243–250PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Sheng-Zhang Lin
    • 1
  • Hong-Fei Tong
    • 1
  • Tao You
    • 1
  • Yao-Jun Yu
    • 1
  • Wei-Jun Wu
    • 1
  • Cong Chen
    • 1
  • Wei Zhang
    • 1
  • Bing Ye
    • 1
  • Chun-Ming Li
    • 1
  • Zhi-Qiang Zhen
    • 1
  • Jia-Rong Xu
    • 1
  • Jun-Liang Zhou
    • 1
  1. 1.Department of General Surgery, Second Affiliated HospitalWenzhou Medical CollegeWenzhouChina

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