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Gastrectomy for Metastatic Gastric Cancer: a 15-year Experience from a Developing Country

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Abstract

The role of surgery in the management of metastatic gastric cancer (MGC) remains unclear. The aim of this study was to investigate the surgical and oncologic outcomes of gastrectomy in patients with MGC. The study included prospectively collected data of patients with MGC operated at four medical centers in Yerevan, Armenia, between 2000 and 2014. Armenian National Center of Oncology Registry and hospital records were used to obtain survival data. Factors associated with performing gastrectomy in patients with MGC were analyzed by using the logistic regression model. The Kaplan-Meier method was applied for survival analysis, and the Cox regression model with backward selection was used for multivariate analysis. A total number of 733 patients were operated for gastric cancer including 112 (15.3%) with MGC. Of those, 70 underwent gastrectomy, while 42 had exploratory laparotomy or bypass. Morbidity and mortality were similar after gastrectomy and exploratory laparotomy/bypass (18.6 vs 21.4%, p = 0.71 and 2.9 vs 7.1% p = 0.36, respectively). Female gender, involvement of N1 and/or N2 lymph node stations, and differentiated adenocarcinoma were associated with opting for gastrectomy. Gastrectomy with synchronous resection of distant metastases resulted in postoperative outcomes similar to those following gastrectomy without synchronous organ resection. Median follow-up was 6 months. Eighteen (16.1%) patients received chemotherapy. Median survival following gastrectomy and exploratory laparotomy/bypass were 7 and 4 months (p = 0.015), respectively. The use of chemotherapy following gastrectomy significantly improved survival compared with gastrectomy only (14 vs 6 months, p = 0.01). In the multivariable analysis, chemotherapy and nodal stage correlated with survival after gastrectomy. Gastrectomy for MGC is associated with satisfactory surgical outcomes and can be combined with synchronous resection of distant metastases in selected patients. Gastrectomy results in longer survival compared with exploratory laparotomy/bypass, especially when followed by chemotherapy.

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Availability of Data and Material

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

MGC:

Metastatic gastric cancer

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Authors and Affiliations

  1. Department of Surgery N1, Yerevan State Medical University After M.Heratsi, Yerevan, Armenia

    Mushegh А. Sahakyan, Airazat M. Kazaryan & Artur M. Sahakyan

  2. The Intervention Center, Oslo University Hospital, Rikshospitalet, 0027, Oslo, Norway

    Mushegh А. Sahakyan, Davit L. Aghayan & Airazat M. Kazaryan

  3. Department of General and Abdominal Surgery, ArtMed MRC, Yerevan, Armenia

    Artak Gabrielyan, Hmayak Petrosyan & Artur M. Sahakyan

  4. Department of Anesthesiology and Intensive Care, ArtMed MRC, Yerevan, Armenia

    Davit L. Aghayan & Shushan Yesayan

  5. Department of Anesthesiology and Intensive Care, Yerevan State Medical University after M.Heratsi, Yerevan, Armenia

    Shushan Yesayan

  6. Department of Chemotherapy, ArtMed MRC, Yerevan, Armenia

    Аlina Chobanyan

  7. Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Tønsberg, Norway

    Airazat M. Kazaryan

  8. Department of Faculty Surgery N2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia

    Airazat M. Kazaryan

  9. Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway

    Airazat M. Kazaryan

Authors
  1. Mushegh А. Sahakyan
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  2. Artak Gabrielyan
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  3. Davit L. Aghayan
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  4. Shushan Yesayan
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  5. Hmayak Petrosyan
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  6. Аlina Chobanyan
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  7. Airazat M. Kazaryan
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  8. Artur M. Sahakyan
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Contributions

All authors have made substantial contributions to research design, as well as have read and approved the final manuscript. Besides that, all authors have participated in the following parts of the manuscript preparation:

Data acquisition—AG, DLA, HP, SY, AC, AMK, and AMS

Data analysis—MAS and AMS

Data interpretation—MAS, AMS, AMK, DLA, SY

Manuscript drafting—MAS and AMS

Critical revision—AG, DLA, HP, SY, AMK, and AC

Corresponding author

Correspondence to Mushegh А. Sahakyan.

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Sahakyan, M.А., Gabrielyan, A., Aghayan, D.L. et al. Gastrectomy for Metastatic Gastric Cancer: a 15-year Experience from a Developing Country. Indian J Surg Oncol 10, 527–534 (2019). https://doi.org/10.1007/s13193-019-00943-4

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  • DOI: https://doi.org/10.1007/s13193-019-00943-4

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